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Citation: Leahy, Michael (2015) To speke of phisik: medical discourse in late medieval English culture. PhD thesis, Birkbeck, University of London.
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1
‘To speke of phisik’: Medical Discourse in Late Medieval
English Culture
Michael Leahy
A thesis submitted to Birkbeck College, University of London, for the
degree of Doctor of Philosophy
January, 2015
2
I declare that the work presented in this thesis is entirely my own
Signed: _________________________
Michael Leahy
3
Abstract
The increased availability and circulation of practical writings on medicine in the
vernacular in late medieval England resulted in a new cultural lexicon heavily informed
by medical learning. This achieved purchase through the blending of a technical,
Latinate vocabulary, rooted in a scholarly European medical tradition, with a one
informed by Christian practices and ritual. This thesis identifies how medical language
provided a constitutive and malleable register that proved amenable to diverse
appropriations. A prominent instance of this was the susceptibility of medical
knowledge to metaphorical deployment: authors of religious texts could elucidate the
abstract theological concepts of sin and salvation by anchoring them in the ailing or
diseased body. In another sense, the supreme physiological knowledge which medical
learning nominally afforded could provide a means of visualising the soul. The
tendency of medical writers to offer normative ideals of the body, as well as of
temperament and character, accorded with religious authors’ concerns of the regulation
of sinful behaviour. Furthermore, medical language offered literary authors a means
both to advance and undermine the idea of a language that could itself be healthinducing. In pursuing the mutually generative interactions between medical, spiritual,
moral and literary discourses, this thesis analyses a wide range of late medieval
writings: they include medical or other technical writings by John Arderne, Guy de
Chauliac and Bartholomaeus Anglicus; literary works by Geoffrey Chaucer and Robert
Henryson; mystical works by Richard Rolle and the Book of Margery Kempe;
hagiographies and sermons; and monastic rules and customaries. It demonstrates the
sweep of themes and concerns that medical discourse could be applied to, including
piety, romance, morality, incarceration, charity, satire and theology. It attests to the
4
productive and significant place of medical language in medieval English culture and its
constitutive role in the development of English literary language.
5
Contents
Abstract
3
List of Illustrations
6
Acknowledgements
7
List of Abbreviations
8
Introduction: Contexts, Method and Medical Rhetoric
1
9
The Practitioner: John Arderne and the Cultural
Contexts of Surgical Writing
61
2
Performing Illness: The Figure of the Patient
125
3
Remedial Spaces and Institutional Language
176
4
The ‘Scabbe of Synne’: Leprosy and its Representations
231
5
Chaucerian Medicine
281
Conclusion
332
Works Cited
350
6
List of Illustrations
Fig.1
Anal fistula images. John Arderne’s Liber medicinalium. 1450-1500.
London, BL Harley MS 5401 f.44v
Fig.2
Woman with mirror. Detail. Stockholm Roll. 1400-1450. Stockholm,
Kungliga Biblioteket MS X.118, Membrane 1(all images from this
manuscript are reproduced with permission from the librarian, National
Library of Sweden)
Fig.3
Woman with pruritus. Detail. Stockholm Roll. 1400-1450. Stockholm,
Kungliga Biblioteket MS X.118, Membrane 1
Fig.4
Writhing or falling figure alongside text of a prayer against cramp.
Detail. Stockholm Roll. 1400-1450. Stockholm, Kungliga Biblioteket
MS X.118, Membrane 2
Fig.5
Skeleton. Detail. Stockholm Roll. 1400-1450. Stockholm, Kungliga
Biblioteket MS X.118, Membrane 1
Fig.6
Anatomical Man, front view. Detail. Stockholm Roll. 1400-1450.
Stockholm, Kungliga Biblioteket MS X.118, Membrane 2
Fig.7
Anatomical Man, rear view. Detail Stockholm Roll. 1400-1450.
Stockholm, Kungliga Biblioteket MS X.118, Membrane 2v
Fig.8
Owl. John Arderne’s Liber medicinalium. 1400-1425. London, BL
Sloane MS 56, f.54v
Fig.9
English Altarpiece. Fragment of the Nativity in Alabaster. 1350-1400.
London, Victoria and Albert Museum, © Victoria and Albert Museum
Fig.10
Nativity Scene. The Taymouth Hours. 1325-1350. London, BL Yates
Thompson MS 13, f.89
Fig.11
English altarpiece. Fragment of the Circumcision of Christ in Alabaster.
1400-1500. London, Victoria and Albert Museum, © Victoria and Albert
Museum
Fig.12
Elizabeth of Hungary. Stained Glass Panel. 1400-1500. Chancel East
Window, St. Peter Mancroft, Norwich (reproduced by permission of St.
Peter Mancroft, Norwich)
Fig.13
Pietà. Stained Glass Panel. 1450-1500. Long Melford Church, Suffolk
(reproduced by permission of the Rector of Holy Trinity Church, Long
Melford)
7
Acknowledgements
This thesis was made possible through an Arts and Humanities Research Council
Doctoral Studentship from 2011-2014.
I wish to thank the librarians and staff at the British Library, Wellcome Library, Senate
House Library and London’s Guildhall Library. I am also grateful to Christina Koch of
the National Library of Sweden for her assistance.
Special thanks are due to my supervisor, Professor Anthony Bale. His steadfast
commitment to the project, lucid criticism and erudite guidance has greatly enriched the
study. I extend further gratitude to staff and students at the School of Arts at Birkbeck.
Heartfelt thanks go to my parents as well as my family and friends. Most especially, I
thank my wife, Shamsad, for her enduring patience, belief and support.
8
Abbreviations
DDGC
H. J. Schroeder, Disciplinary Decrees of the General Councils: Text,
Translation, and Commentary (St. Louis, Mo. and London: B. Herder,
1937).
DR
Douay-Rheims Bible (English translation of the Latin Vulgate).
Online edition: http://unbound.biola.edu.
EETS
Early English Text Society (o.s., Original Series, e.s., Extra Series, s.s.,
Supplementary Series)
GL
Jacobus de Voragine, Gilte Legende, ed. by R.F.S. Hamer, EETS
nos.327, 328, 2 vols. (Oxford: Published for the Early English Text
Society by the Oxford University Press, 2006).
MED
Middle English Dictionary, ed. by Hans Kurath, Sherman M. Kuth and
Robert E. Lewis (Ann Arbor, MI: University of Michigan Press, 19542001). Available at: http://quod.lib.umich.edu/m/med/
ODNB
Oxford Dictionary of National Biography (Oxford: Oxford University
Press, 2004). Online edition: Jan 2008 http://www.oxforddnb.com/
OED
Oxford English Dictionary (Oxford: Oxford University Press, 2014).
Online edition: http://www.oed.com/
RC
Geoffrey Chaucer, The Riverside Chaucer, gen. ed. Larry D. Benson, 3rd
edn. (Oxford and New York: Oxford University Press, 1987)
SEL
Anon., The South English Legendary, ed. by Anna Jean Mill and
Charlotte D’Evelyn, EETS nos.235, 236, 244 (London: Published for the
Early English Text Society by Oxford University Press, 1959).
WB
The Holy Bible in the Earliest English Versions, Made from the Latin by
John Wycliffe and his Followers, ed. by Josiah Forshall and Frederick
Madden (Oxford: Oxford University Press, 1850). Online edition at
‘Corpus of Middle English Prose and Verse’ (Ann Arbor, MI: University
of Michigan Press, 2006) http://quod.lib.umich.edu/cgi/t/text/textidx?c=cme;cc=cme;view=toc;idno=AFZ9170.0001.001
9
Introduction
Contexts, Method and Medical Rhetoric
This thesis identifies and analyses a rhetorical register constellating around medicine in
late medieval England, one which proved remarkably congenial to a variety of contexts
in which the ‘health’ or ‘illness’ of the body was folded with that of the soul. The
vernacularisation of a range of genres of writings in the fourteenth and fifteenth
centuries in England led to a new cultural vocabulary indebted to medical and surgical
knowledge. The mutual circulation of various types of writings (including a significant
amount of technical literature encompassing natural philosophy and medicine), in
addition to the porous boundaries separating many fields of knowledge, resulted in
much linguistic and rhetorical crossover. Yet the porous relationship between religious
and medical languages was particularly significant due to the historical connections
between both, extending back to the beginning of Christianity and arising out of a
shared concern with the ‘health’ of the body and soul. Whilst Christian vernacular
writings continued and developed a longstanding tradition of employing medical
metaphors to elucidate religious concepts in the late medieval period, medical writings
absorbed Christian terms complete with their moral and devotional resonances.
The spread of complex, scholastic medical understandings of illness and disease
encouraged religious writers to appropriate such frameworks in elucidating moral and
behavioural models and requirements. A writer could employ technical languages both
to add gravitas to his argument and encourage the reader’s retention of textual content,
through the application of moral or spiritual qualities to the sick body. This is evident in
The Chastising of God’s Children, an anonymous Middle English text written around
the turn of the fifteenth century. Addressed to a female religious, it comprises a treatise
10
on the advantages of physical and spiritual suffering for the soul. The nine extant
manuscript copies of the complete text, as well as the existence of fragments of it in
other texts, attest to its wide circulation in the fifteenth century.1 In a section on the
causes of a devotee becoming distant from God, the author uses the metaphor of fever
and its symptoms to describe this spiritual malady. The author’s mobilisation of a
learned, scholastic framework, lending intricacy to his account, displays how medical
knowledge and language could be deployed to ‘flesh out’ and ground spiritual concepts.
The author of the Chastising shows a pointed awareness of the medical
taxonomies of the different manifestations of fever. Employing terms associated with a
type identified by medieval medical authors as ‘roted fever’, thought to be caused by the
putrefaction of bodily humours, the writer distinguishes between quotidian (attacks
recurring daily), tertian (attacks intermittently recurring every other day), quartan
(recurring every third day) and double-quartan (a more severe form of quartan) fevers.2
Each fever is linked to a specific type of sinful, or potentially sinful, behaviour.
1
Joyce Bazire and Eric Colledge, ‘Introduction’ in The Chastising of God’s Children
and the Treatise of Perfection of the Sons of God, ed. by Joyce Bazire and Eric Colledge
(Oxford: Blackwell, 1957), pp.37-41.
2
See ‘fever, n’. (3), MED. http://quod.lib.umich.edu/cgi/m/mec/med-
idx?size=First+100&type=headword&q1=fever&rgxp=constrained [accessed 6
December 2014]. For a description of fever, typical of its description in late medieval
European medical university textbooks, see ‘The Isagoge of Joannitius’, in Medieval
Medicine: A Reader, ed. by Faith Wallis (Toronto: University of Toronto, 2010),
pp.139-56 (p.147). From the classical period, medical theory held that four fluids or
humours (blood, phlegm, choler and melancholy) circulated through the body; their
11
Þe first feuer is callid cotidian, whiche is propirly in goostli remeuyng a uariaunce
of þe herte, for sum þer bien þat wol knowen of al þinges and of eche lyueng; þei
wol comune of eche matier, and entremete of eche cause […] Her þouȝtes bien ful
chaungeable, now heere, now þere, now so, now þus, liche to þe wynde. […] þe
secunde feuer is clepid a tercian, whiche may be seid inconstaunce or
vnstablenesse, and al be it þat þis go and come, ȝit it is perilous.3
Identifying the particular qualities germane to the fever type (for instance, the way that
quotidian fever produces changes to the heart), the writer goes on to link these features
to a corresponding behaviour. Thus quotidian fever is keyed to changeable behaviour
whilst tertian fever is linked to those who, despite having lived virtuously, are
susceptible to moral dissolution: ‘if oure lord þanne leuyth hem and suffreþ hem stonde
aloone, sum of hem fallen anon into vnstablenesse’.4 The mode of behaviour becomes
more extreme in line with the severity of the fever up to the onset of double-quartan,
which is aligned with sloth, one of the cardinal sins. The symptoms of the fever are
employed, then, to help the reader recall the variety of ways in which the soul can fall
away from God.
Yet the body is not simply configured here as a means to provide a mnemonic
awareness of different types of erroneous living; it is also implicated itself in such
behaviour. This is manifested in the Chastising through an undermining of the neat
division of metaphorical tenor and vehicle, where the fever and its symptoms become
conflated with the sinful behaviour they symbolise. The author follows the orthodox
relative proportions were thought to determine the state of one’s health (as well as one’s
temperament and character). They are discussed in the next section in relation to the
development of medical theory.
3
Chastising, pp.126-7.
4
Chastising, p.127.
12
medical view in the Middle Ages that cold environments and negligence towards one’s
health brings on fever:
But now ȝe knowen furþermore þat in þis same tyme of þe ȝeer, þe sunne comeþ
doun and þe wedir is ful colde. Þerfor in sum vnwise men and vnauised þe wicked
humoures bien stired and maken þe stomake replete, wherfor thei fallen into
dyuers sikenesse.5
Again, the build-up of humours in the stomach resulting from cold air and negligence
serves to illustrate the spiritual sickness that follows when people ‘bi necligence and
infirmite goon out fro god and out fro þe scole of loue, anon þei wexen so sike þat euer
þei fallen fro uertues, or ellis þei fallen into perel of deeþ’.6 But the physical sickness
seems to be implicated in the spiritual sickness the author describes. The humours that
cause the fever are themselves described as ‘wicked’; likewise an ‘infirmite’ is given as
one of the reasons why one might become distanced from God. In this sense, the
resulting ‘perel of deeþ’ is seen to be caused as much through physical as spiritual
infirmities. Illness is again implicated when the author goes on to describe another
reason as to why the devout become distant from God: this arises from their belief that
they are ‘so fieble and so tendir and wastid for age or for trauel þat al hem þinkeþ
nedeful, what euer þei mowen gete, to þe reste and profite of þe bodi’.7 In this case,
bodily infirmities themselves become harmful for the soul by inducing in the sufferer
too much concern for bodily comforts. The ailing body is marshalled to ground the
concept of sin but, at the same time, is seen as complicit in the causes of sin.
5
Chastising, p.124.
6
Chastising, p.124.
7
Chastising, p.125.
13
In fact, this blending of the bodily and the spiritual reflects the way that
vocabularies of health could be used interchangeably to refer to either. One of the more
popular genres of medical literature in the fourteenth and fifteenth centuries was the
regimen sanitatis, or health regimen, where health is conceived of in such a holistic
way. This genre, associated with the medical school at Salerno in southern Italy but
appearing prominently in vernacular medical literature of the later Middle Ages,
featured advice on maintaining humoral balance, which in turn was thought to ensure
good health, through regulation of the ‘non-naturals’.8 These comprised environmental
8
The theory of the non-naturals held that both physical and environmental factors such
as the quality of air, exercise, sleep, food and the emotions exerted an influence on
one’s general health. See Plinio Prioreschi, A History of Medicine: Medieval Medicine,
Vol. V (Omaha, NE: Horatius Press, 2003), pp.598-602, and Luis García -Ballester, ‘On
the Origin of the “Six Non-Natural Things” in Galen’, in Galen and Galenism: Theory
and Medical Practice from Antiquity to the European Renaissance, ed. by Jon
Arrizabalaga, Montserrat Cabre, Lluis Cifuentes and Fernando Salmon (Aldershot:
Ashgate, 2002), pp.105-15. The Latin text of the Salernitan regimen can be found in
Brian Lawn, ed., The Prose Salernitan Questions (London: Oxford University Press,
1979), p.138. For the history of the regimen, see Prioreschi, History of Medicine,
pp.266-72. Prioreschi, in noting the regimen’s non-theoretical character and basis in
popular herbal and ‘folk’ medicine, speculates that its link with Salerno might have
been established in order to lend the regimen a learned aura (pp.171-2). But the
alignment between the regimen’s advice and the theory of non-naturals suggests an
overlapping between these forms of medical knowledge and practice. On the relation
between the regimen and the non-naturals, see Faith Wallis, ‘The Cultivation of Health:
14
and behavioural factors that were understood to influence the ‘naturals’ (the physical
aspects of the body such as bodily members and humoral fluids). Because the ‘nonnaturals’ included aspects such as food, drink, sleep and the emotions, the moderate
behaviour advanced by health regimens could be understood as carrying religious as
well as medical authority. This is clearly the case in a condensed adaptation of the
Regimen sanitatis salernitanum (the Salerno Regimen of Health) attributed to Suffolk
monk and author, John Lydgate (1370-1451) and known in Middle English as ‘A
Dietarie’.9 This widely disseminated fifteenth-century text begins,
For helthe of body keep fro cold thyn hed,
Ete no rawe mete, take good heed herto,
Drynk holsom wyn, feede the on lyht bred,
With an appetite ryse from thi mete also.10
Lifestyle, Regimen and the Medical Self’ in Medieval Medicine, ed. by Faith Wallis,
pp.485-6.
9
There is evidence for the dissemination of material emerging from Salerno in late
medieval England: the library at Merton College, Oxford, for example, included works
by the notable Salernitan medical scholar Roger Frugard (fl. c.1170). See Vern L.
Bullough, ‘Medical Study at Medieval Oxford’, Speculum, 36:4 (1961), 600-612
(p.609). The Regimen sanitatis is also found in fifteenth-century English medical
miscellanies such as London, Wellcome Historical Medical Library MS 673 and
London, BL Add MS 30338.
10
John Lydgate, ‘A Dietary, and a Doctrine for Pestilence’ in The Minor Poems of John
Lydgate, ed. by Henry Noble MacCracken, EETS o.s. no.192, Vol. II (London: Oxford
University Press, 1934), pp.703-7, l.25-8. Hereafter line numbers are cited in the text.
The ‘Dietarie’ is a translation of an anonymous fifteenth-century Latin poem which
incorporates elements of the Salerno regimen and the Secretum Secretorum, attributed
15
The advice on preserving bodily health continues with suggestions pertaining to sexual
continence, moderate diet and the avoidance of damp conditions. Mixed in with these
are instructions about preserving social decorum including avoiding quarrelling with
one’s neighbours, refraining from deceit and practicing thrift. It also includes Christian
imperatives to visit the poor:
First at thi risyng to God do reverence,
Visite the poore with enteer diligence,
On al nedy have pite & compassioun,
And God shal sende the grace & influence
The tenchrece, & thi possessioun (132-6).
to Aristotle (it is found in London, BL Sloane MS 3534 along with a Middle English
version of the ‘Dietarie’ and other devotional and medical texts). See Jake Walsh
Morrissey, ‘“Termes of Phisik”: Reading Between Literary and Medical Discourses in
Geoffrey Chaucer’s Canterbury Tales and John Lydgate’s Dietary’ (unpublished
doctoral dissertation, McGill University, Montreal, 2011), pp.223-9. Its attribution to
Lydgate is based on its appearance in several manuscripts featuring his work. See Julia
Boffey and A.S.G. Edwards, ‘Literary Texts’, The Cambridge History of the Book in
Britain: 1400–1557, ed. by Lotte Hellinga and J. B. Trapp, Vol. III (Cambridge:
Cambridge University Press, 1999), pp.555 -75 (pp.558-9). For more discussion of the
‘Dietarie’, see Claire Sponsler, ‘Eating Lessons: Lydate’s Dietary and Consumer
Conduct’, Medieval Conduct, ed. by Katheleen Ashley and Robert L.A. Clark
(Minneapolis: University of Minnesota Press, 2001), pp.1-22; Bryon Lee Grigsby,
Pestilence in Medieval and Early Modern English Literature (New York: Routledge,
2004), pp.131-38.
16
From the introductory line, ‘For helthe of body’, no distinction is made between these
pieces of advice, thereby demonstrating that health is conceived as incorporating
‘welthe/ Of sowle & bodi’ (161-2). Through the incorporation of advice pertaining to
physical wellbeing and spiritual progress in verses that evince no formal distinction
between the two, this popular poem demonstrates the tenuous boundaries separating the
religious and the medical spheres. This implicit intersection of both discourses in the
‘Dietarie’ indicates that the employment of medical metaphors in a text like the
Chastising is not to be seen simply as the overlaying of one type of discourse onto
another, but is part of a broader configuration of health shared by both fields.
But does late medieval medical language itself carry moral dimensions? Whilst
scholastic medical texts tend to avoid the kind of explicit moralising that the Chastising
displays in its adoption of the fever motif, an analysis of medical language reveals some
of the moral investments that could have encouraged the author of a work like the
Chastising to inflect medical terms in the way she or he does. The encyclopedic work
by the Paris scholar, Bartholomaeus Anglicus (c.1203-1272), translated into Middle
English by John Trevisa (1342-1402), entitled De proprietatibus rerum (On the
Properties of Things), includes a section on fever where it is classified according to a
similar scheme that is employed by the author of the Chastising. Bartholomaeus
associates fever with extremities of coldness and heat, ‘distemperaunce’ and excessive
humours emanating from the heart and gathering in the stomach.11 Although the
treatment of fevers is here oriented towards the physician’s capability, there is, like the
Chastising, an acknowledgement of the patient’s disposition as a central factor in the
11
Bartholomaeus Anglicus, On the Properties of Things: John Trevisa’s Translation of
Bartholomaeus Anglicus De Proprietatibus Rerum: A Critical Text, ed. by M.C.
Seymour, Vol I (Oxford: Clarendon Press, 1975), pp.379-88.
17
success of treatment. Therefore, when considering treatment for tertian fever,
Bartholomaeus privileges the importance of regimen: ‘ferst diete schal be i-ordeyned as
age and tyme askeþ and vneuennes’.12 Later, he incorporates this idea of the patient’s
responsibility for his own health when advancing reasons as to why a physician may not
be able to cure fever:
As Galien seiþ, in soche yueles somtyme a parfite phisician erreþ for swe[f]tnes of
meuynge of þe matiere [of] þe yuel, and also for defaute oþir vertue of þe pacient,
þe which þe phisican knowiþ nouȝt […]. And hit may nouȝt be vnknowe þat þe
lasse emitricius is curable wiþ difficulte, and þe myddel vnneþe but somtyme it is
curable, and þe grete [fever] neuere but by Goddes owne honde, as Galien seiþ.13
The patient’s ‘vertue’, mentioned here, could refer to his bodily or mental strength or to
the state of his health. In a similar sense, the Chastising describes the perfect devotee of
God gathering the ‘fruyte and erbis of uertues’, again bringing together two
connotations of the word:14 that of cultivating moral excellence and the inherent quality
of a substance (such as a plant). Crucially, the semantic elasticity of the word opens up
potential readings of the spiritual dimensions invested in the overcoming of fever.
The use of ‘yuel’ to describe fever testifies to this fluidity. The word,
etymologically related to ‘ill’ (which came to denote ‘being sick’ only in the later
12
Bartholomaeus Anglicus, Properties of Things, p.387.
13
Bartholomaeus Anglicus, Properties of Things, p.391. Emitricius refers to
intermittent fever.
14
Chastising, p.123.
18
fifteenth century), connoted misfortune or hardship, as well as moral wickedness.15 Its
widespread use in Middle English medical and other writings to describe sicknesses or
symptoms shows again how medical conditions were implicitly accorded a moral
agency. The currency of such a word makes it abundantly clear how moral judgements
were inscribed in the Middle English medical lexicon. The identification of such latent
features, a major commitment of this thesis, reveals how even the most scholastically
oriented, rational medical authors could be subject to incorporating religious or spiritual
modes of discourse. It registers how medical rhetoric, with its religious or moral
semantics, as well as its technical purchase on the ailing or wounded body, proved
susceptible to appropriation in a range of contexts connecting the ‘health’ of the body
and the soul.
The Historical Relationship between Medicine and Christianity
The very identification of the ‘medical’ and ‘religious’ fields or perspectives, even in a
thesis that insists upon their integration, needs to be qualified. This is, in part, because
‘medicine’ was not the primary signifier, as it is today, for the ‘diagnosis, treatment and
prevention of disease’ in the Middle Ages, although the term was sometimes used in
this way.16 Most late medieval texts referred to this practice or art as ‘physic’; this term
15
‘ivel, n. and adj.’, MED
http://quod.lib.umich.edu/cgi/m/mec/medidx?size=First+100&type=headword&q1=ivel
&rgxp=constrained [accessed 6 December 2014].
16
‘medicine, n’ (1), OED
http://www.oed.com.ezproxy.lib.bbk.ac.uk/view/Entry/115715?rskey=YuoUuk&result=
1&isAdvanced=false#eid [accessed 6 December 2014]. The adjective ‘medical’ did not
19
derived from the Latin physica, which denoted the study of natural philosophy, and was
in use from the emergence of scholastic medicine in the twelfth century when medical
writers were keen to stress the theoretical formulation of medical knowledge as a
legitimising factor.17 Because ‘physic’ configured the study of sickness and disease as a
theoretical endeavour, it tended to exclude surgery, which was seen more as a craft, as
well as a great deal of health preservation techniques.18 Although we tend to refer to
‘medicine’ today as an all-encompassing word constituting a variety of health practices,
it is important to acknowledge that no such synonym existed in the Middle Ages. This
reflects the diversity and heterogeneous character of health maintenance and restoration
during this period. As ‘medicine’ could be used to refer to the practice of curing
sickness and disease in the later Middle Ages, I retain the word here to reflect this,
although I acknowledge the very different ideas attending modern usages of the term
and its late medieval application.
The word is rooted in the Latin term medicīna which signified the more general
art or practice of healing in the classical world.19 Medicus correspondingly denoted a
healer, and the appellation of Christus medicus was employed by early Christians to
come into use until the seventeenth century. The modern definition of medicine as
encompassing diagnosis and treatment of illness is usually seen as inseparable from the
medical establishment, which exclusively assumes the role of dispensing this practice.
17
Wallis, ‘Physica: The Advent and Impact of Academic Medicine’ in Medieval
Medicine, ed. by Faith Wallis, p.129.
18
Therefore, the practical use of medical compounds, plasters and purgatives to treat
illnesses was also distinguished from the study of physic.
19
‘medicine, n’ (1), OED.
20
stress Christ’s power of healing the sick.20 This was part of an endeavour by the Church
Fathers, the earliest Christian theologians, in their struggle against the popularity of the
Greek healing god, Asclepius, insisting that it was Christ who was the ‘divine
physician’.21 This idea can itself be traced back to Christ’s words in the gospel of Mark:
‘they that are well have no need of a physician, but they that are sick. For I came not to
call the just, but sinners.22 The metaphor carries an implicit validation and naturalisation
of medical practice in its articulation of Christ’s role of saviour through reference to
medical healing. The early theologians of the Church mostly concurred with this idea:
for St. Basil of Caesarea (c.330-379), the art of medicine was given by God to allow
healing of the sick, whilst his contemporary, St. Augustine of Hippo (354-430),
proposed that the healing properties found in plants and medicines were likewise gifts
from God. But the idea of medicine as a manifestation of God’s willingness that
humanity should make use of such knowledge and practices to overcome sickness and
disease appears paradoxical when seen in context of the Christian economy of sin and
salvation. From this point of view, ill health is a manifestation of man’s post-lapsarian
condition and thus part of the punishment humanity must endure as a result of the Fall.
Therefore, any attempts by physicians or medical practitioners to alleviate or overcome
suffering and illness would seem to work against God’s desire that humanity should
20
Rudolph Arbesmann, ‘The Concept of “Christus Medicus” in St. Augustine’,
Traditio, 10 (1954), 1-28.
21
See Darrel W. Amundsen, Medicine, Society and Faith in the Ancient and Medieval
Worlds (Baltimore, MD and London: John Hopkins University Press, 1996), pp.134-36.
22
DR, Mark 2:17.
21
suffer.23 But the patristic writers addressed this seeming paradox by arguing that God’s
benevolence towards humanity mitigates the necessary punishment it must endure.
According to this perspective, even though humanity and nature are in a fallen state,
God has allowed that man should survive through exploiting nature in the correct
manner.24 Although the idea of what constituted the ‘correct’ use of nature varied from
writer to writer, medical practice was generally considered appropriate to Christians, as
long as it was not prioritised over devotion to God and was not used for purposes
counter to Church teachings. The Alexandrian theologian, Origen (c.182 CE – c.254
CE), for example, in asserting that all wisdom comes from God, suggests that God gave
medical knowledge to men in order to compensate for bodily frailty in the face of
illness.25 In its dual insistence on the importance of enduring physical discomfort or
illness and the legitimacy of seeking to overcoming such conditions, the early Church
held two potentially contradictory attitudes towards illness in balance. This paradoxical
attitude is summed up by St. Jerome (c.347-420),
Am I in health? I thank my Creator. Am I sick? In this case, too, I praise God’s
will. For ‘when I am weak, then am I strong’; and the strength of the spirit is
made perfect in the weakness of the flesh.26
23
Carole Rawcliffe, ‘“On the Threshold of Eternity”: Care for the Sick in East Anglian
Monasteries’, in East Anglia’s History: Studies in Honour of Norman Scarfe,
Christopher Harper-Bill, Carole Rawcliffe and Richard G. Wilson, eds. (Woodbridge,
2002) pp.41-72 (p.41).
24
Amundsen, Medicine, Society and Faith, p.6.
25
Amundsen, Medicine, Society and Faith, p.135.
26
Jerome, ‘Letter XXXIX to Paula’, in Nicene and Post-Nicene Fathers: Jerome’s
Letters and Select Works, ed. by Philip Schaff and Henry Wallace, 2nd Series, Vol. VI
22
The spirit is made strong in this case by the edification that comes about through
suffering, thereby engendering health of the soul. Thus from this perspective, whilst it is
acceptable to seek help from medical practitioners, it is also imperative that, where
medicine does not work, one accepts it as a sign of the will of God and submits oneself
to enduring the illness stoically.
Acceptance of medical practice by Church authorities is further demonstrated by
the provision of medical care (and its nascent regulation) as one of ‘the defining
characteristics of Christian monasticism, in evidence from the very beginnings of
monastic social organisation in the early fourth century’.27 The monastic imperative to
care for the sick is enshrined in the Rule of St. Benedict, written by the Italian monk
Benedict of Nursia (c.480-c.543). This rule, written in the early sixth century,
‘predominated from the eight to the twelfth centuries in Britain and all the western
Church alike’.28 Chapter thirty-six states, ‘Before all things and above all things care
(Grand Rapids: Eerdmans, 1893; repr. New York: Cosimo Books, 2007), pp.49-54
(p.50).
27
Andrew T. Crislip, From Monastery to Hospital: Christian Monasticism and the
Transformation of Health Care in Late Antiquity (Ann Arbor, MI: University of
Michigan Press, 2005), p.9.
28
Christopher Cannon, ‘Monastic Productions’, in The Cambridge History of Medieval
English Literature, ed. by David Wallace (Cambridge and New York: Cambridge
University Press, 1999), pp.316-48 (p.316).
23
must be taken of the sick, so that they may be served in every deed as Christ himself’.29
As the Rule goes on to show, this emphasis is informed by a specific biblical edict: the
words of Christ in Matthew’s gospel, ‘“I was […] sick and you visited me”’ and ‘“as
long as you did it to one of these my least brethren, you did it to me”’.30 The care of the
afflicted remained thereafter a fundamental aspect of the Christian ministry, and this is
reflected in many of the rules and customaries of English monasteries that follow the
Benedictine Rule in giving priority to the care of the sick.31
Indeed, monastic communities were the main preservers and disseminators of
medical information in western Europe throughout late antiquity and the Middle Ages
until this monopoly was challenged by the rise of universities in the twelfth century. 32
29
The Rule of Saint Benedict, ed. by Justin McCann (London: Sheed and Ward, 1937),
p.91.
30
DR, Matthew 25:35-36 and 40.
31
Greg Peters, ‘Religious Orders and Pastoral Care in the Late Middle Ages’, in A
Companion to Pastoral Care in the Late Middle Ages (1200-1500), ed. by Ronald J.
Stansbury (Leiden and Boston: Brill, 2010), pp.263-84 (p.279); Amundsen, Medicine,
Society and Faith, p.13. Riccardo Cristiani also notes how the sanctity of benefactors
was often seen as proportional to the sickness of those in their care. See Riccardo
Cristiani, ‘Integration and Marginalization: Dealing with the Sick in Eleventh-Century
Cluny’, in From Dead of Night to End of Day: The Medieval Customs of Cluny, ed. by
Susan Boynton and Isabelle Cochelin (Turnhout: Brepols, 2005), pp.287-95 (p.294).
32
M.K.K. Yearl, ‘Medieval Monastic Customaries on Minuti and Infirmi’, in The
Medieval Hospital and Medical Practice, ed. by Barbara Bowers (Hampshire, UK and
Burlington, VT: Ashgate Publishing, 2007), pp.175-94 (p.179).
24
Clerics, both regular and secular, not only had knowledge of medicine and surgery but
were also practitioners during this time. But a number of Church reforms, initiated in
the twelfth and thirteenth centuries, which sought to curb some of these practices by
clerics, indicate deep unease with this situation on the part of the Church hierarchy. In
1139, the second Lateran Council, a general council held under Pope Innocent II
(d.1143), decreed that those in regular orders (clerics living under a rule) should refrain
from practicing jurisprudence or medicine for economic gain.33 Although this did not
specifically order those regular clerics from ceasing the study and practice of medicine
per se, it did inveigh heavily against those who prioritised health of the body over the
needs of the soul. It has been reasonably argued that the Church was more worried that
the economic benefits of practicing medicine would entice regular clerics away from
performing their duties than the fact that they were practicing it at all.34 But in 1215, the
Fourth Lateran Council, held that ‘no subdeacon, deacon or priest shall practice that part
of surgery involving burning and cutting’; it thereby effectively excluded those in major
orders from practicing surgery.35 Again, this did not amount to a condemnation of
medical practice; it rather reflected the Church’s fear that ‘the risk of accidental
homicide, […] jeopardised a monk’s ability to perform his priestly duties’, as well as its
concern that the pollution of blood or other bodily fluids on priests’ hands might make
33
Darrel W. Amundsen, ‘Medieval Canon Law on Medical and Surgical Practice by the
Clergy’, Bulletin on the History of Medicine, 52:1 (1978), 22-44 (p.28).
34
F.M. Getz, ‘The Faculty of Medicine before 1500’, in The History of the University of
Oxford: Late Medieval Oxford, ed. by J.I. Catto and Ralph Evans, Vol. II (Oxford:
Clarendon Press, 1992) pp.373-405 (p.381).
35
DDGC, pp.258 and 569.
25
them unfit to handle the Eucharist.36 Whatever the immediate success of its
implementation, there does appear to have been an increasing separation between
medicine and surgery in later medieval Europe, where the laity gradually started to
make up the numbers of surgeons.37 By the thirteenth century, some English
monasteries began to employ laymen to perform operations involving surgery.38
Although clerics continued to study medicine, the entry of qualified physicians in the
medical marketplace in increased numbers in the fourteenth century, as well as the use
of physicians in the royal household during the Hundred Years’ War, eventually
contributed to the secularisation of the profession in England.39
36
Rawcliffe, ‘Care for the Sick’, p.46.
37
See Carole Rawcliffe, Medicine and Society in Later Medieval England (Stroud:
Sutton, 1997), p.126, and Piorsechi, pp.287-8.
38
Rawcliffe, ‘Care for the Sick’, pp.46-47. However, as Nancy G. Siraisi states, the
breach between medicine and surgery ‘always remained partial and incomplete’. Both
fields shared a mutual conceptual framework and the interest in compound medicines,
diet and lifestyle evinced in surgical treatises demonstrates how porous such boundaries
could be in practice. See Siraisi, Medieval and Early Renaissance Medicine: An
Introduction to Knowledge and Practice (Chicago and London: University of Chicago
Press, 1990), pp.174-5.
39
Getz, ‘Faculty of Medicine’, p.393-94. See also E.A. Hammond ‘Physicians in
Medieval English Religious Houses’, The Bulletin of the History of Medicine, 32
(1958), 105-120 (pp.118-9).
26
Yet, even in 1215, Lateran IV did acknowledge a split between what it called
‘physicians of the body’ and ‘physicians of the soul’, and it proceeded on this basis to
attempt to align these different interests along hierarchical lines:
We declare in the present decree and strictly command that when physicians of
the body [medicis corporum] are called to the bedside of the sick, before all else
they admonish them to call for the physicians of the souls [medicos animarum], so
that after spiritual health [spirituali salue] has been restored to them, the
application of bodily medicine [corporalis medicinae] may be of greater benefit,
for the cause being removed the effect will pass away.40
According to this text, the secular physician is to stand aside and allow the cleric to
diagnose the patient and apply remedies in ‘rebuke, counsel and penance’.41 Illness,
from this perspective, is either caused by a spiritual deficiency or is a manifestation of
it; whilst the involvement of the medical practitioner is not questioned here, it is only in
the context of confession and spiritual acknowledgment on the part of the patient that a
medical cure can come about. Although the health of the soul is prioritised in this edict,
the religious practice of confession is not seen to replace medical therapies but renders
them more effective in bringing about the cure of the body. The decree goes on, ‘and
since the soul is far more precious than the body, we forbid under penalty of anathema
that a physician advise a patient to have recourse to sinful means for the recovery of
bodily health’.42 Physicians could work against ‘the health of the soul’, for example, by
disturbing religious fasting or sexual continence, through advocating eating or sex as a
means to regulate the humors. The decree makes plain the way that the intrinsic
40
DDGC, p.570. The English translation is provided at p.263.
41
John T. McNeill, A History of the Cure of Souls (New York and London: Harper and
Row, 1951), p.111.
42
DDGC, pp.263 and 570.
27
relationship between religion and medicine, both being concerned with ‘health’, could
be subject to tension and opposing interests.43
The combative tone of these edicts aligns with one of the main objectives
emerging out of Lateran IV: that is, the need to define the Christian community through
orienting it in opposition to what the Church perceived as that community’s greatest
enemies, including heretics and Jews.44 Despite the historical integration between
Christianity and medicine, a great deal of classical medical knowledge was unknown in
the West for much of the medieval period; during the same time, medical learning
flourished in Muslim and Jewish cultures where classical medical knowledge was
preserved over many centuries. This medical culture began to filter into western Europe
in the eleventh century and came to comprise an over-arching field of ‘rational’
knowledge where diseases and their treatment were understood according to theoretical
(mainly humoral) principles. This process was expedited by the rise of universities and
medical schools across Europe in the same century. Therefore, the Lateran IV edicts
that attempt to regulate or curb medical practice are of a piece with the Church’s
attempt to define itself against potential challenges to its authority. The
institutionalisation of medicine in the new universities may have been perceived as a
threat. Indeed, scholastic medicine occupied an ambivalent position in the sense that it
43
Jessalyn Bird, ‘Medicine for Body and Soul: Jacques de Vitry’s Sermons to
Hospitallers and their Charges’, in Religion and Medicine in the Middle Ages, ed. by
Peter Biller and Joseph Ziegler (York: York Medieval Press, 2001), pp.91-108 (p.92).
44
See R.I. Moore, The Formation of a Persecuting Society: Authority and Deviance in
Western Europe, 950-1250, 2nd edn. (Malden, MA and Oxford: Blackwell Publishing,
2007), especially pp.6-11.
28
was, in part, perceived as a Christian legacy whilst also seen as a Muslim and Jewish
enterprise. This explains the efforts by the writers of the Lateran IV edicts to tolerate
and regulate medical practice whilst holding it at a distance.
Yet despite attempts by Church authorities to sequester scholastic medicine, it
continued to grow in stature and popularity over the following centuries. One of the
reasons for this was the way that rational medicine, offering a totalising philosophy,
complemented, and helped propel, a late medieval appetite for an all-encompassing
knowledge. The Greek philosopher and physician, Galen of Pergamon (c.130-c.210
CE), is often held to be the originator of scholastic medicine: in the third century he
linked the Hippocratic idea of four constituent humours of the body – blood, choler,
phlegm and melancholy – with the four elements and bodily temperaments.45 He also
outlined a detailed understanding of anatomy and physiology as well as the theory and
practice of uroscopy, allopathy and surgery.46 He instituted the concept of humoral
balance or harmony by developing a theory that viewed all diseases as arising from the
excessive or diminished presence of one or more humours in the body, and he promoted
techniques such as phlebotomy as a means of ridding the body of excessive humoral
matter. Whilst certain Galenic works were known in the West throughout late antiquity
45
The Hippocratic corpus comprises medical writings attributed to the Greek physician
Hippocrates (c.460-c.370 BCE). These exerted tremendous influence on medical theory
throughout the classical and medieval periods. See Hippocratic Writings, ed. by G.E.R.
Lloyd (New York: Penguin Books, 1978).
46
Alain Touwaide, ‘Galen’, in Medieval Science, Technology and Medicine: An
Encyclopedia, ed. by Thomas F. Glick, Stephen J. Livesey and Faith Wallis (New York
and London: Routledge, 2005), pp.179-82 (p.179).
29
and the Middle Ages, many others were lost, but continued to be the focus of medical
authority in the Arab and Jewish worlds. Following the first major translations into
Latin of the Arabic canon by Constantinus Africanus (d. c.1090) and the establishment
of the Italian city of Salerno as a centre of medical learning, Galen’s corpus re-emerged
with vigour in the European tradition, complete with extensive commentaries by writers
such as Ibn Sīnā, known in the West as Avicenna (c.980-c.1037) and Ibn Rushd, or
Averroes (c.1126-c.1198).47 The ‘New Galen’ became a central feature of scholastic
learning. 48 This was not only for the huge body of knowledge it brought to bear on
European medical learning, but also for its amenability in helping to situate medicine
within a ‘“new model of equilibrium” as it was emerging in a host of disciplines in the
first decades of the fourteenth century: from economic, political and ethical thought to
theology and natural philosophy’.49 By the later Middle Ages, Galen remained by far
the most cited medical authority in medical texts across Europe; reference to his status
47
Joel Kaye, A History of Balance, 1250-1375: The Emergence of a New Model of
Equilibrium and its Impact on Thought (Cambridge and New York: Cambridge
University Press, 2014) pp.210-11; Cornelius O’Boyle, The Art of Medicine: Medical
Teaching at the University of Paris, 1250-1400 (Leiden: Brill, 1998), pp.268-9.
48
Luis García -Ballester, ‘The New Galen: A Challenge to Latin Galenism in
Thirteenth-Century Montpelier’, in Galen and Galenism, ed. by Jon Arrizabalaga,
Montserrat Cabre, Lluis Cifuentes and Fernando Salmon, pp.55-83.
49
Kaye, History of Balance, p.211.
30
as classical authority had, by then, spread from the confines of university textbooks to
writings in the wider culture.50
The Galenic corpus, together with the many commentaries it engendered, was
markedly sizable. Its centrality to the curricula in the medical schools and universities
that emerged in Europe from the twelfth century meant that it began to be circulated in
compendia, bound with the treatises of other commentators and authorities. Founding
texts were the Isagoge of the Baghdad physician Hunyan ibn Ishaq, or Iohannitus
(c.809-873), which comprised an introductory text to the main Galenic principles, and
Constantinus’s translation of a work by Haly Abbas (d.982-994), known as the
Pantegni.51 These works were gathered together with others including the Galenic texts,
the Aphorisms of Hippocrates, Constantinus’s Viaticum and the materia medica of
Dioscorides (c.40- c.90CE), under the rubric of the Ars medicine (later printed as the
Articella).52 Versions of this text were structured according to an a capite ad calcem
format where diseases and illnesses were dealt with in a sequential head-to-toe order,
with each section being composed of passages from the relevant authority.
The emergence of surgery as a discrete discipline in the twelfth and thirteenth
centuries was itself accompanied by the production of ‘comprehensive and detailed
50
Irma Taavitsainen, ‘Science’, in A Companion to Chaucer, ed. by Peter Brown
(Oxford and Malden, MA: Blackwell, 2002), p.390.
51
On the adaptation of the Isagoge and Pantegni for a Latin readership, see the
collection of essays in Charles Burnett and Danielle Jacquart, eds., Constantine the
African and ʻAlī Ibn Al-ʻAbbās Al-Maǧūsī: The Pantegni and Related Texts (Leiden:
Brill, 1994).
52
See O’Boyle, Art of Medicine, pp.82-127.
31
Latin treatises that would transform this branch of medical learning’.53 One of the most
important early examples of this was the Chirurgia of Roger Frugardi (d. c.1195), a text
read and glossed at Salerno. This text set the template for subsequent surgical treatises:
it outlined a scholastic, deductive model for the study of surgery based on identifying
the causes of each condition, its diagnosis and a detailed description of the surgical
procedure.54 It was followed by such landmark works as Lanfranc of Milan’s (d.1315)
Chirurgia Magna, written in 1296, and Guy de Chauliac’s (c.1300-1368) Inventarium
seu collectorium in parte cyrurgicali medicine, written in Avignon in 1363.55
By the fourteenth century, medical knowledge had begun to be disseminated
beyond the sphere of university learning and assumed a more heterogeneous character
appearing in manuscripts with empiric material as well as in popular encyclopaedic
works.56 In England, a non-scholastic vernacular remedy book tradition, including
53
Faith Wallis, ‘The Practice of Surgery Rationalised: The Surgery of Roger Frugard’,
in Medieval Medicine, ed. by Faith Wallis, p.181.
54
See Tony Hunt, The Medieval Surgery (Woodbridge: Boydell Press, 1992), p.xii.
Hunt points out that Roger’s Chirurgia was in fact written by his students from his
teachings (p.xii).
55
See Wallis, ‘A Primer on Bloodletting: Lanfranc of Milan’s Scholastic Phlebotomy’
in Medieval Medicine, ed. by Faith Wallis, p.281, and Margaret S. Ogden’s preface to
The Cyrurgie of Guy de Chauliac, ed. by Margaret S. Ogden, EETS o.s. no.265, Vol I:
Text (London, New York and Toronto: Published for the Early English Text Society by
the Oxford University Press, 1971), p.v.
56
Irma Taavitsainen and Päivi Pahta, ‘Vernacularisation and Medical Writing in its
Sociohistorical Context’, in Medical and Scientific Writing in Late Medieval English,
32
astrological, herbal material and charms, had existed from around the ninth century. By
the thirteenth century, a substantial amount of medical texts had been written in AngloNorman.57 In the later Middle Ages, such material was not only produced alongside
surgical works and academic treatises but in many cases merged with them.
The ‘rational’ orientation of scholastic medicine, with its classical heritage based
upon deducing medical treatment from humoral principles, and its twelfth-century
development in the new universities of Europe, has led medical historians to privilege
its secular features. This has led to views that it was only occasionally infiltrated by
Christian or empiric content.58 Yet there does appear to have been some ambivalence
towards ‘folk’ remedies on the part of some of the canonical scholastic writers: Bernard
of Gordon (c.1258-1320), who taught at the University of Montpelier, despite
condemning the use of textual amulets in medicine, included in his Lilium medicine
ed. by Irma Taavitsainen and Päivi Pahta (Cambridge and New York: Cambridge
University Press, 2004), pp.1-18 (p.10).
57
Taavitsainen and Pahta, ‘Vernacularisation’, p.11. For the merging of scholastic
works with empiric medicine in England, see Claire Jones, ‘Elaboration in Practice: The
Use of English in Medieval East Anglian Medicine’, in East Anglian English, ed. by
Jacek Fisiak and Peter Trudgill (Cambridge: D.S. Brewer, 2001), pp.163-78.
58
See for example, Wallis, ‘Physica’, in Medieval Medicine, ed. by Faith Wallis,
pp.129-30. I employ the term ‘rational’ to refer to deductive, theoretical medicine;
however, I argue that this understanding of medicine is persistently blended with
religious perspectives, particularly in Middle English writings.
33
descriptions of amulets and apotropaic sayings for the cure of epilepsy.59 Another
hugely influential work by Gilbertus Anglicus (c.1180-c.1250) included empirical cures
and incantations.60 In a more general sense, the presence of the six non-naturals
(mentioned above) sat easily alongside the Christian injunction towards moderation and
control of the passions.61 Whatever the tensions between scholastic medicine and
traditions of religious or magical healing, the miscellaneous character of medical
writings (particularly in the vernacular) in fourteenth- and fifteenth-century England
resulted in a tradition where religious and medical material were received
interchangeably by an emergent non-scholastic readership.
Analysing Medical Discourse through a Medical Humanities Framework
The study embarked upon in this thesis, focusing on medical language and its
appropriations and inflections in a variety of genres, is to be distinguished from the field
of the history of medicine. This field comprises the main discipline through which
understanding of medieval medicine has taken place. From its nineteenth-century
genesis to the 1960s and early 1970s, this area of study constituted a metanarrative that
59
Luke E. Demaitre, Doctor Bernard de Gordon: Professor and Practitioner (Toronto:
Pontifical Institute of Medieval Studies, 1980), pp.158-9.
60
Monica H. Green, ‘Gilbertus Anglicus’, in Medieval Science, Technology and
Medicine: An Encyclopedia, ed. by Thomas F. Glick, Stephen Livesy, Faith Wallis
(New York and Abingdon, Oxon, 2005), pp.196-7. See also Esther Cohen, The
Modulated Scream: Pain in Late Medieval Culture (London and Chicago: University of
Chicago Press, 2010), p.95.
61
Siraisi, Medieval and Early Renaissance Medicine, p.101.
34
unquestioningly charted medical ‘progress’ through history (usually tracing its genesis
to the Enlightenment period) and focused on its ‘great men’, or individuals associated
with particular medical innovations.62 In the 1970s, Susan Reverby and David Rosner
questioned this critical complacency by situating medical history in its political and
economic contexts.63 The subsequent influence of postmodernism further eroded the
division between biology and culture, and it led to the development of social
constructionism in the field. This perspective understood medical knowledge ‘not as an
incremental progression towards a more refined and better knowledge, but as a series of
relative constructions that are dependent upon the socio-historical settings in which they
occur and are constantly negotiated’.64 These realignments were of a piece with the
approach embarked upon by historian Roy Porter comprising an integrated perspective
of the medical marketplace in place of the traditional ‘medicine from above’ approach.
62
See, for example, P.V. Renouard, History of Medicine: From its Origin to the
Nineteenth Century, trans. by Cornelius G. Comegys (Cincinnati: Moore, Wilstach,
Keys and Co., 1856). For the development of the ‘history of medicine’, see Deborah
Lupton, Medicine as Culture: Illness, Disease and the Body in Western Societies
(London: Sage, 2003), pp.9-11, and Charles E. Rosenberg, ‘Framing Disease: Illness,
Society and History’, in Framing Disease: Studies in Cultural History, ed. by Charles
E.Rosenberg and Janet Golden (New Brunswick: Rutgers, 1992), pp.xiii- xxvi.
63
Susan Reverby and David Rosner, eds., Health Care in America: Essays in Social
History (Philadelphia: Temple University Press, 1979).
64
Lupton, Medicine as Culture, p.11.
35
Such an approach viewed the patient as an active agent rather than passive recipient of
medical care.65
Around the same time, the study of English medieval medical history expanded
through Edward Kealey’s exploration of the increase in medical practice and hospitals
in the Anglo-Norman period and Linda Ehrsam Voigts’s translations and extensive
cataloguing of medical manuscripts.66 Notable studies that have since emerged in this
field are Carole Rawcliffe’s work on hospitals and local medical provision in East
Anglia, Monica Green’s study of late medieval medical literacy, particularly amongst
women, and Faye Getz’s description of scholastic medical learning at Oxford.67
65
See Roy Porter, Patients and Practitioners: Lay Perceptions of Medicine in
Preindustrial Society (Cambridge: Cambridge University Press, 1986) and ‘The
Patient’s View: Doing History from Below’, Theory and Society, 14 (1985), 175-98.
66
Edward Kealey, Medieval Medicus: A Social History of Anglo-Norman Medicine
(Baltimore and London: John Hopkins University, 1981); Linda Ehrsam Voigts and
Michael R. McVaugh, trans. and ed., A Latin Technical Phlebotomy and its Middle
English Translation, (Philadelphia: American Philosophical Society, 1984); Voigts, A
Handlist of Middle English in Harvard Manuscripts (Cambridge, Mass.: Harvard
University Library, 1985) and ‘The Character of the Carecter: Ambiguous Sigils in
Scientific and Medical Texts’, in Latin and Vernacular: Studies in Late-Medieval Texts
and Manuscripts, ed. by Alastair Minnis (Cambridge: D.S. Brewer, 1989), pp.91-109.
67
Carole Rawcliffe, Medicine for the Soul: The Life, Death and Resurrection of an
English Medieval Hospital St. Giles’s, Norwich, c.1249-1550 (Stroud: Sutton, 1999).
See also Rawcliffe’s ‘Care for the Sick’ and ‘The Hospitals of later Medieval London’,
Medical History, 28 (1984), 1–21. For Monica H. Green, see ‘The Possibilities of
36
Additionally, there are a number of studies that have teased out various aspects of the
relationship between medieval medicine and religion: they include Darrel Amundsen’s
broad study of the history of this relationship and a volume of essays on the subject
edited by Peter Biller and Joseph Ziegler.68 Yet the debates among medical historians of
this interaction have not significantly developed beyond the question of orthodox
Christianity’s acceptance, or tension with, medical healers or, conversely, the extent to
which medical practitioners incorporated Christian requisites in their practice.69 What is
required is an analysis of the language employed in medical and religious works, as well
as texts from other genres, where medical learning is appropriated. Such a focus,
encompassing features including rhetorical qualities, lexical choice and other formal
Literacy and the Limits of Reading: Women and the Gendering of Medical Literacy’, in
Women’s Healthcare in the Medieval West, ed. by Monica H. Green (Aldershot:
Ashgate, 2000), Section VII, pp.1-76. For Faye Getz, see ‘Faculty of Medicine’,
pp.373-405.
68
Amundsen, Medicine, Society and Faith; Peter Biller and Joseph Ziegler, eds.,
Religion and Medicine in the Middle Ages (York: York Medieval Press, 2001).
69
See, for example, the contrasting perspectives adopted by Darrel Amundsen and
Michael McVaugh on the influence of Lateran IV’s proscription to physicians to call for
a priest when treating patients: Darrel W. Amundsen, ‘The Medieval Catholic
Tradition’, in Caring and Curing: Health and Medicine in the Western Religious
Traditions, ed. by Ronald L. Numbers and Darrel W. Amundsen (New York:
MacMillan, 1986), pp.65-107; Michael R. McVaugh, Medicine before the Plague:
Practitioners and their Patients in the Crown of Aragon, 1285-1345 (Cambridge and
New York: Cambridge University Press, 1993), p.171. I discuss this debate in more
detail in chapter two of this thesis.
37
qualities, should provide insights on the implicit, often unacknowledged, associations
circulating between these fields.
This thesis, comprising such an analysis, does not employ a ‘history of medicine’
methodology. It does not propose new perspectives on how the relationship between
medicine and religion affected medical practice, knowledge or morality in late medieval
society. Instead, it offers an analysis of the meanings and ideologies invested in medical
language, and the ways that these are dispersed across different fields of knowledge and
cultural modes. To this end, it adopts a methodology based upon the burgeoning field
of the medical humanities.
Although driven by a variety of theoretical approaches and critical perspectives,
medical humanities scholarship broadly represents the view that, as biomedicine is
geared towards conceiving of health and illness largely in terms of diagnosis and cure,
there needs to be a concurrent understanding of the social and cultural experiences and
significance of ‘being healthy’ or ‘being ill’.70 The humanities, with their long tradition
of enquiry into the human subject, sensitivity to social and cultural frameworks and
their engagement with critical perspectives of language and the body, are seen to be
ideally placed to fill this lacuna. The field emerged from the critical identification and
questioning of ideologies underpinning scientific medicine during the 1960s, and over
the last twenty years has developed into a coherent methodological and inter-
70
See Karl Jaspers, General Psychopathology, eds. and trans. by J. Hoenig and Marian
W.Hamilton, Vol II (Manchester: Manchester University Press, 1963), pp.779-81.
38
disciplinary field.71 Of particular importance to its genesis has been the work of the
Hungarian psychoanalyst Michael Balint, in particular his book The Doctor, his Patient
and the Illness. Balint argues that the clinical experience is defined by a ‘confusion of
tongues’ arising from a disjunction between the patient’s language, based on the
subjective experience of suffering, and that of the practitioner, grounded in medicalscientific terminology.72 This separation between doctor and patient became a central
theme of the emerging field and this was given impetus in the early 1990s by the work
of Eric Cassell. He suggests that the doctor-patient relationship should be remodelled to
privilege the treatment of the patient’s suffering over that of the disease.73
Two broad strands of enquiry have arisen from these concerns: one comprises
critical and political engagements with medical practice and is concerned with the role
of the arts and humanities in re-imagining or re-structuring the clinical encounter; the
other has focused on the patient’s experience of suffering or being ill and the role of
narrative, in particular, in the construction of a patient-identity.74 This ‘narrative turn’
71
David Greaves, ‘The Nature and Role of the Medical Humanities’ in Medical
Humanities, ed. by Martyn Evans and Ilora G. Finlay (London: BMJ Publishing, 2001),
pp.13-22 (pp.13-14).
72
Michael Balint, The Doctor, his Patient and the Illness (Edinburgh: Churchill
Livingstone, 2000; orig. pub., 1957), see p.26.
73
Eric J. Cassell, The Nature of Suffering and the Goals of Medicine, 2nd edn., (Oxford
and New York: Oxford University Press, 2004; orig. pub., 1991).
74
See Martyn Evans and Ilora G. Finlay, ‘Introduction’, in Medical Humanities, ed. by
Evans and Finlay, pp.1-12 (p.7); Angela Woods, ‘Post-narrative: An Appeal’, Narrative
Inquiry, 21:2 (2011), 399-406 (p.401).
39
has informed anthropological and sociological approaches within the medical
humanities, as well as the appropriation by some of phenomenology as a means to
frame the subjectivity of the patient or sufferer.75 Such a confluence of approaches
underlines the distinctiveness of the field in ‘bringing social-scientific and literaryphilosophical approaches if not together then at least into conversation’.76 This interest
in narrative has also attracted contributions to the field from literary scholars interested
in the ways that illness and medical care are represented in both fictional and nonfictional texts.77
75
For anthropological and sociological works see Roland Littlewood, ‘Why Narrative?
Why Now?, Anthropology and Medicine, 10.2 (2003), 255-61; Arthur Frank, The
Wounded Storyteller: Body, Illness, and Ethics (Chicago and London: University of
Chicago Press, 1995); Paul Atkinson, ‘Illness Narratives Revisited: The Failure of
Narrative Reductionism’, Sociological Research Online, 14:5 (2009)
http://www.socresonline.org.uk/14/5/16.html [accessed 6 June 2014]. For
phenomenological perspectives on illness see, Havi Carel, Illness: The Cry of the Flesh
(Stocksfield: Acumen, 2008), and S. Kay Toombs, The Meaning of Illness: A
Phenomenological Account of the Different Perspectives of Physician and Patient
(Dordrecht, Boston and London: Kluwer Academic Publishers, 1992).
76
Angela Woods, ‘Rethinking “Patient Testimony” in the Medical Humanities: The
Case of Schizophrenia Bulletin’s First Person Accounts’, Journal of Literature and
Science, 6:1 (2013), 38-54 (p.38).
77
See Catherine Belling, A Condition of Doubt: The Meanings of Hypochondria
(Oxford and New York: Oxford University Press, 2012); Cynthia Ryan, ‘“Am I Not a
Woman?”, The Rhetoric of Breast Cancer Stories in African American Women’s
40
Recently, however, there has been a critical backlash towards the medical
humanities’ privileging of narrative. This criticism has centred on the way that narrative
is often proposed as a means to offer a direct, unmediated insight into the patient’s
internal experience as a sufferer or medical subject.78 Angela Woods points to the
implications underpinning such narratives, or ‘misery memoirs’, and suggests that they
incorporate ‘notions of the narrative self as a transcultural transhistorical “truth”’.79
Thus, whilst sensitivity on the part of health professionals towards the narratives of
patients has often been proposed as a way of countering medicine’s impersonal focus on
disease, this has involved an effacement of the constructed nature of narratives, and of
the way they are historically and culturally mediated. Indeed, this informs a wider
Popular Periodicals’, The Journal of Medical Humanities, 25:2 (2004),129-50; Laura
L.Behling ‘Replacing the Patient: The Fiction of Prosthetics in Medical Practice’, The
Journal of Medical Humanities, 26:1 (2005), 53-66.
78
Rita Charon, in particular, proposes ‘narrative medicine’, based upon practitioners’
empathetic engagement with patients through the development of sensitivity to
narrative, as a remedy for what she perceives as flaws in modern medical practice. See
Rita Charon, Narrative Medicine: Honoring the Stories of Illness (Oxford and New
York: Oxford University Press, 2006), pp.3-6.
79
Woods, ‘Post-Narrative’, p.404. Woods arguments reflect a wider questioning of the
assumed importance of narrative in modern culture; much of this discussion has been
instigated by philosopher, Galen Strawson’s influential essay, ‘Against Narrativity’,
Ratio, 17 (2004), 428-452. For more discussion of this in a medical context, see Paul
Atkinson, ‘The Contested Terrain of Narrative Analysis – an Appreciative Response’,
Sociology of Health and Illness, 32:4 (2010), 661–7, and Seamus O’Mahony, ‘Against
Narrative Medicine’, Perspectives in Biology and Medicine, 56:4 (2013), 611-19.
41
critique of the subservient relationship of the humanities to medicine embedded in some
articulations of the medical humanities. From this perspective, the humanities are seen
as ‘course or discipline content injected into, or grafted onto, a medicine curriculum as
compensation, complement or supplement’ (original emphasis); 80 the humanities are
thus conceived as fulfilling the work of ‘humanising’ medicine. The implicit hybridity
of the term ‘medical humanities’ itself evokes this idea of the splicing of discrete
disciplines.81
Jeffrey P. Bishop, in particular, argues that the conception of the field as a
utilitarian model participates in the same Western dualism that informed the
development of bio-medicine itself. As an alternative, he suggests that by querying the
‘false’ divisions of the subject and object, theoria and praxis and art and medicine,
divisions underlined by Western metaphysical thought, the medical humanities can
more radically offer perspectives that critique the dominant medical model.82 Following
Martin Heidegger, Bishop argues that as humans ‘think’ their own being through
language, medicine, like literature and philosophy, constitutes ‘one of many endeavours
of Being, of the writing of human being’.83 Such insights can lead to an alternative
relationship where the humanities can ‘show medicine that its language about biological
80
Alan Bleakley, Robert Marshall and Rainer Bromer, ‘Toward an Aesthetic Medicine:
Developing a Core Medical Humanities Undergraduate Curriculum’, Journal of
Medical Humanities, 27 (2006), 197–213 (p.200).
81
Bleakley, Marshall and Bromer, ‘Aesthetic Medicine’, p.206.
82
Jeffrey P. Bishop, ‘Rejecting Medical Humanism: Medical Humanities and the
Metaphysics of Medicine’, Journal of Medical Humanities, 29 (2008), 15–25 (pp.15-6).
83
Bishop, ‘Rejecting Medical Humanism’, p.23.
42
being is already a language within which the biopsychosociologisms live, a language
that mediates, perhaps even distorts, the being of patients’.84
By proposing language as a principle factor in the gathering, dissemination and
transformation of scientific knowledge, Bishop summons Michel Foucault’s insights of
the working of knowledge and power in relation to medical practice. Foucault’s work, a
towering influence on the medical humanities, has served to undermine modern
medicine’s claim to possessing an objective and empirical knowledge; one of its
principal ways of doing this is by revealing medical ‘advances’ to be epistemic breaks
brought about by discursive reorganisation. In The Birth of the Clinic, Foucault
connects the beginnings of modern medicine in the eighteenth-century medical school,
or clinic, with the implementation of the ‘clinical gaze’. For Foucault, this gaze, enabled
by the homogeneous, stable space of the clinic (as well as the centrality of the
temporally arrested cadaver allowing anatomical mapping to take place),85 came to
define the typical relationship of the medical encounter where the active, knowledgeable
doctor inspects and treats the passive, inert patient. The practitioner’s gaze is given
force through its legitimisation by the medical field, a field that comprises a series of
gestures, moral authority and a technical language made up of codes of knowledge:
‘The gaze that traverses a sick body attains the truth that it seeks only by passing
84
Bishop, ‘Rejecting Medical Humanism’, p.24.
85
See Edward S. Casey, ‘The Place of Space in The Birth of the Clinic’, The Journal of
Medicine and Philosophy, 34:4 (2009), 328-349 (pp.352-3).
43
through the dogmatic stage of the name’ [original emphasis].86 Foucault argues that the
gaze both isolates and re-absorbs disease ‘into, all the other social ills to be eliminated;
and […] isolates it, with a view to circumscribing its natural truth’.87 Medicine can thus
claim for itself a neutral, objective agency whilst postulating normative ideas of the
healthy subject, ideas that inform ‘the standards for physical and moral relations of the
individual and of the society in which he lives’.88 Much of the power invested in
medicine to circumscribe the medical subject is manifested in rhetorical tropes that
circulate both in medical discourse itself and popular accounts of illness and disease.
Susan Sontag, for instance, has shown how metaphors surrounding cancer and
tuberculosis express fantasies of punishment and contamination, fantasies often related
to wider political and social anxieties.89
86
Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception,
trans. by A.M. Sheridan Smith (London and New York: Routledge, 1973, repr., 1989),
p.72.
87
Foucault, Clinic, p.50. However, this argument ignores the way that medical
discourse and practice can be appropriated or undermined by the medical subject. See
Deborah Lupton, ‘Foucault and the Medicalisation Critique’, in Foucault, Health and
Medicine, ed. by A. Petersen and R. Burton (London: Routledge, 1997), pp.94-110.
88
Foucault, Clinic, p.40.
89
Susan Sontag, Illness as Metaphor (New York: Farrar, Straus and Giroux, 1977). For
martial and polemical representations of disease, see Georges Canguilhem, A Vital
Rationalist: Selected Writings from Georges Canguilhem, ed. by Francois Delaporte
(New York: Zone Books, 2000), pp.323-5.
44
But if the ‘clinical gaze’ is exemplified through the encounter between an
authority and a subject, the folding of moral with physical ‘sickness’ and the institution
of a circumscriptive language, its exclusive location within post-Enlightenment
medicine may be questioned. One of the objectives of this thesis is to identify a similar
‘gaze’ operating in late medieval medical languages authored by, among others,
monastic authorities, writers of devotional material and romance or literary authors.
The application of a medical humanities methodology can in this way prise open the
inherent assumptions and ideologies informing the production of medical discourse in
the Middle Ages. For example, by undertaking ‘literary’ readings of medical treatises, it
is possible to identify how concepts of illness, health or wellbeing are rhetorically
constructed, and how these constructions are often mediated through power or its
subversion. The focus on language and discourse also yields insights into the shared
elements that cross discrete disciplinary boundaries and can illuminate the often
unnoticed intersections and overlap between various disciplines.
Therefore, the medical humanities illuminates my research into late medieval
medical languages by providing a framework in which I conceive of medieval medicine,
not as a discrete independent entity, but as a way of ‘doing’ language that is bound up
with other practices and discourses. Therefore, medicine and religion are not to be seen
as discrete entities but as generating mutual linguistic and rhetorical features. By
examining intrinsic concepts such as ‘healing’ and ‘wholeness’, and the way they are
deployed in such writings, I shed light on the way that such concepts would have been
received and understood by late medieval readers.
This thesis also participates in the recent critical interest in the relationship
between medicine and culture in the Middle Ages. This interest emerged from the ‘turn’
to the body of the 1980s and 1990s. Caroline Walker Bynum’s ground breaking work
45
on the role of the body in medieval devotional practices, Holy Feast and Holy Fast, is
particularly significant.90 Here Bynum overturns a prior critical orthodoxy, which
perceived medieval Christianity in terms of an exclusive interest in transcending the
limitations of the body. She shows instead how the symbolism invested in sacred bodily
fluids, such as milk and blood, highlights how the body, far from being rejected, was
seen by medieval people as a means to provide access to spiritual experience.91 This
interest in exploring the significance and the symbolism of the body in late medieval
culture has been developed by Miri Rubin, exploring how Christ’s body mediated ideas
of wholeness and form, and Sarah Beckwith, who examines the symbolism of Christ’s
body as both determining, and being constituted by, social organisation and culture in
the later Middle Ages.92
90
Caroline Walker Bynum, Holy Feast and Holy Fast: The Religious Significance of
Food to Medieval Women (Berkeley and Los Angeles: University of California Press,
1987). Other important works by Bynum on this subject are Fragmentation and
Redemption: Essays on Gender and the Human Body in Medieval Religion (New York:
Zone Books, 1991) and The Resurrection of the Body in Western Christianity, 200-1336
(New York and Chichester: Columbia University Press, 1995).
91
Bynum, Holy Feast, pp.165-88 and pp.260-293.
92
Miri Rubin, ‘The Person in the Form: Medieval Challenges to Bodily “Order”’, in
Framing Medieval Bodies, ed. by Miri Rubin and Sarah Kay (Manchester and New
York: Manchester University Press, 1994), pp.100-22; Sarah Beckwith, Christ’s Body:
Identity, Culture and Society in Late Medieval Writings (London and New York:
Routledge, 1993).
46
The more recent theoretical interest in disability studies has also impacted
medievalists’ approaches to the body.93 Edward Wheatley has been one of the first to
deploy disability studies in his analysis of late medieval literary stereotypes of blind
people. For Wheatley, this methodology offers a perspectival framework which enables
an identification of the way blindness was constructed as a species of immorality in the
later Middle Ages. However, Wheatley adapts disability studies to the exploration of
premodern culture arguing that ‘the modern medical model, whereby science and the
medical profession dominate discourse about disability in order to keep it within their
domain, generally does not apply to the Middle Ages’.94 Wheatley proposes instead a
‘religious model’ of disability showing how the Church, rather than institutional
medicine, produced and controlled its meanings.95 His opposition between ‘medical’
93
This is a growing field within medieval studies. In addition to the works by Edward
Wheatley and Irina Metzler discussed here, significant works in the field include
Christopher Baswell, ‘King Edward and the Cripple’, in Chaucer and the Challenges of
Medievalism: Studies in Honor of Henry Ansgar Kelly, ed. by Donka Minkova and
Theresa L. Tinkle (Frankfurt: Lang, 2003), pp.15-28; Tory V. Pearman, Women and
Disability in Medieval Literature (New York and Basingstoke: Palgrave Macmillan,
2010); Joshua R. Eylar, ed., Disability in the Middle Ages: Reconsiderations and
Reverberations (Farnham and Burlington, VT: Ashgate Publishing, 2010); Jonathan
Hsy, ‘Blind Advocacy: Blind Readers, Disability Theory, and Accessing John Gower’,
Accessus: A Journal of Premodern Literature and New Media, 1:1 (2013), 1-38
http://scholarworks.wmich.edu/accessus/vol1/iss1/2 [accessed 6 December 2014].
94
Edward Wheatley, Stumbling Blocks before the Blind (Michigan: University of
Michigan, 2010), p.x.
95
Wheatley, Stumbling Blocks, pp.8-9.
47
and ‘religious’ constructions of disability are themselves grounded on the wider dualism
operating in disability studies between impairment (the anatomical, physical condition)
and disability (its social construction).96 This opposition is affirmed by Irina Metzler in
her study of medieval ideas of impairment, arguing that ‘[disability] implies certain
social and cultural connotations that medieval impaired persons may not have shared
with modern impaired people’.97 However, this view poses the impaired body as an
ahistorical and universally stable entity preceding its discursive representations; such a
perspective itself emerges from a modern medical tendency to differentiate between the
biological, ‘natural’ body and its socio-cultural encodings, a distinction the medical
humanities problematises.98
In this sense, ‘impairment’ has applicability for medievalists attempting to
dislodge the modern medical indices embedded in ‘disability’, but not as a way to efface
its socially constructed basis. Similarly, Wheatley’s attempt to get beyond modern
96
For a definition of these by the Union of the Physically Impaired Against
Segregation, see Irina Metzler, Disability in Medieval Europe: Thinking about Physical
Impairment in the High Middle Ages, c.100-1400 (London and New York: Routledge,
2006), pp.20-21.
97
Metzler, Disability in Medieval Europe, p.2.
98
For a Foucauldian critique of this distinction, see Bill Hughes, ‘What Can a
Foucauldian Analysis Contribute to Disability Theory?’, in Foucault and the
Government of Disability, ed. by Shelley Tremain (Michigan: University of Michigan,
2005), pp.78-92. Although Metzler concedes the problems attending this distinction, she
does maintain it as an organising framework. See Metzler, Disability in Medieval
Europe, pp.21-22.
48
medical ideas of disability by conceiving of the medieval Church’s institutional control
over responses to impairment (in contrast to today’s medical and scientific one) is
problematic: this is because it elides the role of medical authors themselves in informing
such meanings in the Middle Ages. Although this thesis, in its analysis of medical
languages, goes beyond the conditions typically accepted as germane to disability
studies by those working in the field, it shares with it an interest in questions of textual
and cultural construction, marginalisation and power.
The study of medical metaphor and rhetoric in medieval writings has been
enriched by a number of recent studies. Jeremy J. Citrome’s The Surgeon in Medieval
English Literature, charts the surgeon’s appearance as a significant figure in fourteenthcentury literature, and studies the way that surgery informed religious metaphors.99
Citrome ranges over theological, penitential, literary and surgical material to underline
99
Jeremy J. Citrome, The Surgeon in Medieval English Literature (Basingstoke and
New York: Palgrave Macmillan, 2006). Virginia Langum also investigates the
relationship between surgical and confessional language. See Langum, ‘Discerning
Skin: Complexion, Surgery, and Language in Medieval Confession’, in Reading Skin in
Medieval Literature and Culture, ed. by Katie L. Walter (New York and Basingstoke:
Palgrave Macmillan, 2013), pp.141-60. Danielle Jacquart and Claude Thomasset focus
on medical and theological discourse in their wide-ranging study of medieval medical
conceptions of human sexuality. They argue that medical language was distinct from
theological discourse and thus had liberating qualities. See Danielle Jacquart and
Claude Thomasset, Sexuality and Medicine in the Middle Ages, trans. by Matthew
Adamson (Princeton and New Jersey: Princeton University Press, 1988). Conversely, I
argue in this thesis that medical language is embedded in the wider culture.
49
‘the social power of metaphor as it affected English society in the later Middle Ages’.100
Louise M. Bishop has also explored medical metaphors in her study of healing words
and their material formulations.101 Like Citrome, Bishop is interested in the
metaphorical power of medical concepts and materials, particularly in the way that they
are deployed to ground the theological idea of Christian redemption. The use of medical
metaphors, as a way of mediating the interface between body and soul, physical
materiality and religious ‘truth’, reveals inherent ruptures in the movement from text to
body and vice versa. The work of Julie Orlemanski is oriented to such tensions; she
argues that the emergent medical vocabulary of the fourteenth and fifteenth centuries
presented new possibilities to reach beyond the text to the bodies of readers and
patients. But she finds that medical language invokes conflicts where ‘the text at hand,
rather than elevating the reader to an elite community of expertise, binds him or her all
the more tightly in the conditions of embodiment and materiality that medicine has
pretensions to overcome’.102 Central to Orlemanski’s analysis is the way that medical
discourse contributes to the reading of bodily signs and the particular modes of
subjectivity that emerges in the later Middle Ages. Again, drawing on a mix of medical
works, moral writings and literary texts, Orlemanski identifies points where medieval
100
Citrome, Surgeon in Medieval English Literature, p. 2.
101
Louise M. Bishop, Words, Stones and Herbs: The Healing Word in Medieval and
Early Modern England (New York: Syracuse University Press, 2007).
102
Julie Orlemanski, ‘Jargon and the Matter of Medicine in Middle English’, Journal of
Medieval and Early Modern Studies, 42:2 (2012), 395-420 (p.415).
50
religious and medical languages overlap, but also where they are held in productive
tension.103
In this work, I develop the study of medical discourse in Middle English writings
in new ways. Undertaking sustained readings of the dissemination of medical language
in a diverse array of writings, I highlight the rhetorical overlapping, particularly
between medical and religious texts, to affirm the generic blurring between these fields.
Whereas Citrome’s and Bishop’s analyses are focused on textual content, the
examination here opens out to consider how the medical, religious and literary are
bound up at the level of manuscript production and reception. Like Citrome, I consider
the figure of the late medieval surgeon but, again, I depart from his largely
psychoanalytical reading of the surgical text by situating the surgeon-author in both his
medical and literary milieus. Informing the readings of medical discourse here, then, is a
marked sense of an emergent professional coterie of practitioners using the medical text
and its language as a means to engender legitimacy and authority. It is within such
settings that I place the medical subject. I extend upon Orlemanski’s view of the newly
vernacularized medicine shaping the medical subject by considering this subject in
relation to institutional imperatives, and by analysing the way that regulatory languages
work to generate and delimit the medical subject and the structures it inhabits.
Moreover, this thesis contrasts with others in the field through the way its theoretical
perspectives are mediated through a tight focus on the historical and cultural context of
late medieval England.
103
Julie Orlemanski, ‘Desire and Defacement in The Testament of Cresseid’, in Reading
Skin, ed. by Katie L. Walter, pp.161-81, and ‘How to Kiss a Leper’, postmedieval: a
journal of medieval cultural studies, 3 (2012), 142-57.
51
Research Objectives
Recognition of the abiding presence of medical tropes and references in a plethora of
Middle English writings prompted the research questions that inform this thesis. The
variety of manifestations of medical knowledge across different genres raises the
question of how a Middle English medical register is articulated. In what contexts is it
employed or invoked? A common way in which medical language is made to work in
different writings is through metaphor. This deployment, often mobilising a detailed and
intricate knowledge of rational, scholastic medicine, leads me to ask, what is it about
such medical language that makes it so amenable to metaphorical appropriation? How
does a medically-invested rhetoric relate to Christian perspectives of spiritual health?
One avenue of research arising from this question concerns the extent to which the
ailing or diseased body may be conceived of as anchoring abstract theological concepts,
like the doctrine of salvation, and rendering such concepts visible on the material body.
This question applies not just to religious writings, which employ medical knowledge,
but also, conversely, to the way that medical writings subsume religious elements. The
overlap between medical references and spiritual content in different writings,
particularly where one is used to affirm the validity or legitimacy of the other, raises a
question of power relations. What types of hierarchies are affirmed, or contested, in the
cultural dissemination of medical language? Does, for example, the incorporation of
medical references in religious writings disturb the cultural hierarchy which privileges
spiritual over medical healing? One prominent feature of the way both religious and
medical fields constitute themselves is in the textual construction of the subject. The
medical encounter is often outlined in terms of the confessional or instructional ones.
What are the features of the late medieval medical subject? How does it relate to the
devotional or confessional one? Crucially, the presence of medically-informed tropes
52
and subjects in literary works raises questions of the relationship between medical and
literary culture in late medieval England and the degree to which we can understand the
development of an English literary language in terms of a medical poetics.
Such questions underpin the research objectives of this thesis. These are: to
articulate how vernacular medical languages operate across different English writings,
and the literary effects of their widespread dissemination; to probe the relationship
between the medical and religious fields through an analysis of their shared rhetorical
and lexical properties, and to explore how this overlap problematises a view of both
fields as discrete ones in late medieval culture; to examine the way that the bleeding of
medical language into the wider late medieval English culture incorporates questions of
power, authority and discipline; to delineate the features of the medical subject and
probe its textual construction and relationship with other kinds of subjectivity
(particularly religious); and to examine the generative role of medical languages within
late medieval literary culture.
As this thesis is distinct from a medical history, it does not comprise a wholesale
account of the different ways that medicine was practiced according to different social
groups; neither is it concerned with the way that moral norms may have impinged upon
and informed its dispensation. It is pitched at the stratum of the text and achieves
leverage from identification of the moral, authoritative or subversive encodings of
medical language across a diverse array of literature. Therefore, I undertake close
literary analysis of a range of texts to unpack the ideological co-ordinates and cultural
stakes attending the appropriation of medical discourse by such authors. The aim of
providing an analysis of the way medical language works in late medieval English
culture has led me to choose a wide range of primary sources. Most of the material I
study was written or produced between the late fourteenth and mid-fifteenth centuries, a
53
period during which the new availability of scholastic medical texts in the English
vernacular coincided with an increase of vernacular literary and religious works.
I have therefore pursued a methodology which mixes material which has
traditionally fallen under the purview of literary scholars with that which has tended to
resist such analysis, or which has been marginal to the interests of literary scholars. I
have chosen ‘literary’ texts such as the N-Town ‘Nativity’ play and the Book of
Margery Kempe as well as poetry by Geoffrey Chaucer, John Lydgate and Robert
Henryson, because these works and authors employ medical learning and language,
often in creative and exploratory ways. I have also selected more explicitly religious
material that engages with medical concepts, often as a means to elucidate religious
ideas: these include sermons, mystical treatises, saints’ lives, visionary literature,
institutional documents and edicts as well as manuscript illustrations and carvings. A
thesis on medical language needs to engage with writings by medical authors
themselves (as well as other technical writings that touch on the medical), and I study a
variety of such treatises, paying particular attention to prefaces where authors often state
their motivations and affirm their claims to authority and legitimacy. These include
writings by anonymous authors as well as treatises by John Arderne, Guy de Chauliac,
Benventus Grapheus, Batholomaeus Anglicus and John Bradmore. Such a range of
primary literature can provide broad and comprehensive evidence of the circulation of
medical language in late medieval culture, and allow the identification of rhetorical and
literary patterns in order to assess its salient qualities. By comparing the way that
medical concepts cluster around particular ideas and concepts, my analysis can help
develop new understandings of the role of medical rhetoric in the wider vernacular
culture in the late Middle Ages.
54
One way that this can be accomplished is through an exploration of the kind of
readership that medical writings in particular might have attracted. Although the
pedagogical format of medical or surgical treatises call up a professional readership, the
presence of devotional or other elements in such texts raises the possibility of a wider
readership for such works. Therefore, I devote space to the materiality of such texts
encompassing analyses of illustrations, signs of use and manuscript circulation to gain
an insight into this topic.
Due to the far-reaching qualities of this evidence and the themes that emerged
from its analysis, the extent of the thesis is narrower than I had originally envisioned.
Consequently, there are topics that, although discussed in the thesis, could have been
developed into complete chapters. These include women’s medicine, children’s
medicine, folk healing including use of magic and herbals, bad medicine and
miraculous healing.104 All of these carry potential for avenues of future scholarship.
104
For important work undertaken on women’s medicine in the Middle Ages, see
Monica Green, Making Women’s Medicine Masculine: The Rise of Male Authority in
Pre-Modern Gynaecology (Oxford and New York: Oxford University Press, 2008);
Beryl Rowland, ‘Exhuming Trotula, Sapiens Matrona of Salerno’, Florilegium, 1
(1979), 42-57; Joan Cadden, Meanings of Sex Difference in the Middle Ages: Medicine,
Science and Culture (Cambridge and New York: Cambridge University Press, 1993);
Amy Lindgren, The Wandering Womb and the Peripheral Penis: Gender and the
Fertile Body in Late Medieval Infertility Treatises (California: University of California
Press, 2005). For a medical outline of child-rearing see Michael E. Goodich,
‘Bartholomaeus Anglicus on Child-Rearing’, Lives and Miracles of the Saints: Studies
in Medieval Hagiography, ed. by Michael E. Goodich (Aldershot: Ashgate, 2004),
55
Thesis Outline
In this analysis of the dissemination of medical language, I argue that the transmission
of scholastic, Latinate medicine into the English vernacular in the late fourteenth and
fifteenth centuries promoted a generative and supple register that proved amenable to
appropriation in a variety of contexts; these include social, political, spiritual and
literary ones. Therefore, different writings from this period exhibit sustained
overlapping between the medical and other registers, particularly the religious. For these
reasons I focus on the period covering c.1380-1450, a period notable for the widespread
production of medical literature, newly translated into the vernacular, in England, as
well as the deployment of medical language across other genres.
pp.27-84. For an analysis of language and ‘folk’ healing see Bishop, Words, Stones and
Herbs, and Don C. Skemer, Binding Words: Textual Amulets in the Middle Ages
(University Park, PA: Pennsylvania State University Press, 2006). For history of charms
and prayers, see Lea T. Olsan, ‘Charms and Prayers in Medieval Medical Theory and
Practice’, Social History of Medicine, 16:3 (2003), 343-66. For herbs, see Werner
Telesko, The Wisdom of Nature: The Healing Powers and Symbolism of Plants and
Animals in the Middle Ages, trans. by Stephen Telfer (Munich and London: Prestel,
2001), and Tony Hunt, Plant Names of Medieval England (Cambridge: D.S. Brewer,
1989). For a study of magic in medieval culture, see Richard Kieckhefer, Magic in the
Middle Ages (Cambridge and New York: Cambridge University Press, 1989). For
medieval miracles see, Ronald C. Finucane, Miracles and Pilgrims: Popular Beliefs in
Medieval England (London: Dent, 1977), and Michael E. Goodich, Violence and
Miracle in the Fourteenth Century: Private Grief and Public Salvation (Chicago and
London: University of Chicago Press, 1995).
56
This work is distinctive through its identification and theorising of the saturation
of medical discourse in Middle English culture, exhibited in an assortment of different
genres. I propose that this pervasiveness constituted a medical poetics where medical
knowledge and terminology were widely adopted and rhetorically modulated to engage
with questions of power, legitimacy, religious devotion, philosophy, marginality and
institutionalisation. Given the historical cross-pollination between medicine and
Christianity, the developing technical vocabulary of disease and healing emerging in
late medieval medical vernacular works resonated strongly with Christian thought.
Importantly, as I show in this work, medical rhetoric was not just transposed from
medical writings to religious or literary works but informed the language in medical
treatises too. This medical poetics had some distinct components: medical language was
especially prone to metaphorisation for the way it could formulate theological notions
materially and so help orient the concepts of sin, punishment and salvation in terms of
the ailing body; the technical register of scholastic medicine, comprising a total
knowledge of the body (particularly its hidden recesses), could inform conceptions of
the soul; the moral overtones accompanying medical descriptions of illness and disease
could be harnessed by writers to both imagine institutional marginality and the
fulfilment of the Christian imperative of practicing charity. Much like the incorporation
of, for example, psychoanalytical terms such as ‘ego’ or ‘hysteria’ in everyday parlance
in the modern world, certain features of medical language found purchase in the wider
literature of the later Middle Ages. Identifying the ways that medical language could
float between different registers, I argue that it was a central feature in the development
of Middle English literary language.
These specific explorations also shed light, more generally, on medicalisation, the
theme that is the subject of much current political and sociological debate. It is typically
57
understood today as a process where previously non-medical problems or issues are
increasingly being defined and treated within a medical domain.105 By demonstrating
how Middle English texts evince the tenuous boundaries between the ‘medical’ and
‘non-medical’, I show how this process is not exclusive to Western modernity. Whilst
scholastic medicine, from its inception in the classical world, always carried moral and
spiritual resonances, the dissemination of medical terms and concepts across a variety of
fields, as well as the circulation of medical manuscripts with other material, in the
fourteenth and fifteenth centuries, bespeaks a pronounced insinuation of the medical in
other spheres.
It is also important to recognise the ways that medieval medicine itself could
incorporate different ideas of healing. Whilst scholastic medicine was formulated
according to principles of order and systematisation (principles endemic to the idea of
modern medicine), it did not entirely preclude the practice of magic, miraculous
intervention and folk remedies, although these issues were debated amongst medical
authors. But even at its most ‘rational’, scholastic medicine, as mentioned above, was
understood as operating within a cosmological hierarchy arranged with God as the
source of all knowledge and power. This hierarchy embraced the most mundane and
quotidian aspects of human life and the body. Certainly, where medical material was
being translated into the English vernacular and circulated amongst a lay readership, the
distinction between scholastic medicine and prayer remedies or amuletic charms in the
resulting compilations and commonplace books was often non-existent. Despite the fact
105
Peter Conrad, The Medicalization of Society: On the Transformation of Human
Conditions into Treatable Disorders (Baltimore: John Hopkins University Press, 2007)
p.4.
58
that historians readily point out the radical differences separating the theory and
practices of medieval medicine to modern medicine, there endures a tacit assumption of
medieval medicine as a discrete and self-contained institution. Therefore, I adopt much
circumspection when approaching the idea of medieval medicine and I aim to promote
an understanding of it that is sensitive to the particular ways in which it was understood
and conceived of by late medieval readers. This is especially so in terms of the way it
was subsumed into the wider culture (particularly the religious culture) and the
symmetries and tensions germane to this.
The first two chapters of the thesis focus on the figures of the practitioner and
patient, two archetypes around which constellated a host of moral and spiritual
resonances. Chapter one explores the writings of the fourteenth-century London
surgeon-author, John Arderne. Here I undertake literary readings of fifteenth-century
Middle English translations of Arderne’s works to probe their incorporation of moral
edicts, cultural encodings and authoritative stratagems; in doing this, I outline the ways
in which the late medieval practical surgical text is socially and culturally mediated. I
also investigate the cultural milieu in which Arderne and his works operated within, and
I assess its proximate relationship to contemporary literary culture. The second chapter
concentrates on the self-legitimising efforts of practitioners like Arderne and considers
the importance of the patient-figure to such manoeuvres. I explore the patient’s textual
emergence in Middle English writings, such as in a treatise on ophthalmology, and
show how the category was pre-inscribed with the Christian attributes of submission
and forbearance. I suggest that the ideal patient was typically defined in masculine and
aristocratic terms, and I chart the constitution of this figure in romance literature,
focusing on two texts by Geoffrey Chaucer. But I turn to the Book of Margery Kempe
and representations of the Virgin Mary in Nativity scenes and drama to consider the
59
precise (and sometimes subversive) delineations of the female patient. This chapter
demonstrates how the presence of spiritual or devotional language was not simply
grafted on to medical language by self-serving medical authors, but was more
fundamentally embedded in the very terms used by such authors and re-appropriated,
with its medical inflections, by religious and literary writers.
I proceed by turning to the importance of institutional spaces to articulations of
sickness and disease and their invocations of the medical subject, occupying the
interstices of regulation and edification. Chapter three examines how descriptions and
accounts of the monastic infirmary and hospital in regulatory and devotional writings
employ medical language to outline the morally and physically deviant subject. Such
writings imagine spatial hierarchies and order through the transition of the institutional
subject from aberrance to integration, and from sin to salvation. I show how this
dynamic infiltrates other institutional spaces by analysing portrayals of the prison and
purgatory in a hagiography and a visionary account of the otherworld. The question of
regulation and the medical subject is highly pertinent to representations of leprosy, the
theme which I explore in chapter four. Leprosy’s superlative status as a category of
illness had much to do with the symptomatic fluidity with which it was depicted as well
as the excessive moral indices that congregated about it. Exploring the correspondences
between lovesickness and leprosy, through comparing Chaucer’s Troilus and Criseyde
with Robert Henryson’s sequel The Testament of Cresseid, I show how leprosy acquired
its cultural potency through its amenability to a variety of moral configurations. I go on
to trace how this condition is exemplified in sermons, hagiographies and mystical
literature through a paradoxical impetus to distance leprosy sufferers and incorporate
them in affective and pietistic practices. I go on to look at the way a similar dynamics is
60
mapped on to institutional and ritualistic writings concerning the management and
regulations of lepers.
Throughout the thesis, I investigate the construction of a medical poetics where
the practical and technical language of rational medicine blends with moral,
authoritative, devotional and amatory languages. In the final chapter, I evaluate this
interlacing in light of Geoffrey Chaucer’s oeuvre. His writings, coinciding with the
vernacularisation and increased dissemination of medical learning in late medieval
England, record a pronounced interest in medical language, particularly its multi-faceted
nature and its heterogeneous usages. Yet studies of Chaucer’s use of medical language
continue to focus mainly on his satirical treatment of medical practitioners. This chapter
insists that anti-medical satire is just one of a variety of ways that Chaucer employs
medical discourse. This discourse also offers a framework for his explorations of
philosophy, religion, authority, terminology and romance. Chaucer’s consistent
engagement with medical language exemplifies its important place in the emerging
English literary vernacular. In closing a thesis that began by considering Chaucer’s
London contemporary John Arderne and his contact with literary culture, this final
chapter suggests that the diversity characteristic of Chaucerian medicine emerges from
the mutual circulation of medical and literary material in fourteenth-century England. It
thus affirms that the register of late medieval medicine in England was not a discrete
phenomenon but consistently mingled with other cultural registers.
61
CHAPTER ONE
The Practitioner: John Arderne and the Cultural Contexts of Surgical
Writing
The Practica of Fistula-in-ano, outlining medical treatment for anal fistula, by the
fourteenth-century surgeon, John Arderne (c.1307-c.1377), features a preface in which
Arderne promotes his reputation as a successful and innovative practitioner. Part of his
strategy is to list the high-status patients he has effectively cured of the disease at
Newark in Nottinghamshire and in his subsequent practice in London:
Aftirward, in the ȝere of oure lord 1370, I come to london, and ther I cured Iohn
Colyn, Mair of Northampton […] Aftirward I helid or cured Hew Denny,
ffisshmanger of london, in Briggestrete; and William Polle, and Raufe Double;
and oon that was called Thomas Broune […] And a ȝong man called Thomas
Voke.1
This glimpse into Arderne’s practice reveals his involvement with a close network of
wealthy London professionals. It furnishes a cursory glimpse into the life and career of
a figure for whom no confirmed biographical information exists, apart from the sketchy
details he himself provides in his writings. Compellingly, Arderne’s connection with his
London patients includes a possible literary dimension: Marion Turner has recently
identified that the name ‘Thomas Voke’ is rendered in many of the forty extant
1
John Arderne, Treatises of Fistula in Ano, Hæmorrhoids, and Clysters, ed. by D’Arcy
Power., EETS o.s.no.139 (Published for the Early English Text Society by Kegan Paul,
Trench, Trübner and Co., 1910), p.2.
62
manuscripts of the Practica as ‘Thomas Uske’.2 Turner’s research into the other names
on Arderne’s list of London patients reveals their movement ‘within the same
commercial and social network’ of which Thomas Usk (c.1354-1388), administrator,
scrivener and author of the Boethian allegorical prose work Testament of Love, was a
member.3 Official records reveal that Ralph Double and William Polle were, like Hugh
Denny, fishmongers and both Denny and Double were members of a faction opposing
John Northampton (d.1398), mayor of London and employer of Usk; this animosity
seems to have stemmed from Northampton’s popular attempts to undermine the power
of the victualing guilds in London.4
The mercantile and political orientation of Arderne’s patient-list is given a
literary dimension with the identification of Usk and opens up the possibility of a
textually-based connection between the surgeon-author and his patient. Indeed,
evidence of the expanding ownership of books by English merchants and other
professionals in the fourteenth and fifteenth centuries, comprising religious, literary and
practical (including medical) material, indicates the cultural investments that might have
attended such interactions.5 The case of Roger Marchall, a fifteenth-century physician
2
Marion Turner, ‘Thomas Usk and John Arderne’, The Chaucer Review, 47:1 (2012),
95-105.
3
Turner, ‘Thomas Usk and John Arderne’, p.99.
4
See Ronald Waldron, ‘Thomas Usk’, ODNB,
http://www.oxforddnb.com/view/article/28030 [accessed 8 December 2014].
5
See Kathleen L. Scott, ‘Past Ownership: Evidence of Book Ownership by English
Merchants in the later Middle Ages’, in Makers and Users of Medieval Books: Essays in
Honour of A.S.G. Edwards, ed. by Carole M. Meale and Derek Pearsall (Cambridge:
63
and book owner/writer, who amassed much wealth from an involvement with London’s
ironmongers, affirms the braided connections that could link the late medieval
mercantile, medical and textual spheres.6 The affiliations between medicine and other
fields was also present at the level of book production: as I discuss in more detail below,
some of Arderne’s works travelled in miscellanies with religious and other works;
furthermore, Kathleen L. Scott has noted the similarities between the illustrations in
some of the manuscripts of Arderne’s works and those decorating various religious and
literary works, including Sir Gawain and the Green Knight in London, BL Cotton Nero
MS A.X.7
One significant outcome of the identification of Usk, as a patient and sufferer of
anal fistula, in the pages of the Practica is that it encourages a reassessment of the way
D.S. Brewer, 2014), pp.150-177; Sylvia L. Thrupp, The Merchant Class of Medieval
London (Chicago: University of Chicago Press, 1948), pp.247-55.
6
See Linda Ehrsam Voigts, ‘Roger Marchall’, ODNB,
http://www.oxforddnb.com/view/article/45763 [accessed 8 December 2014]. Marchall
is discussed in more detail in chapter five of this thesis.
7
Scott finds a close resemblance between the illustrations accompanying Arderne’s
Practica in London, BL Sloane MS 2002 and those in London, BL Cotton Nero MS
A.X. See Kathleen L. Scott, Later Gothic Manuscripts 1390–1490, Vol. II (London:
Harvey Miller Publishers, 1996), p.67. Scott also identifies parallels between the
illustrations in Arderne’s works in London, BL Add MS 29301 and those in a number
of religious works including a Psalter in London, BL Add MS 6894 and miniatures of
the Arma Christi in San Marino, Huntington Library, MS HM 142, see Scott, Later
Gothic Manuscripts, p.201.
64
that Arderne has been constituted by medical historians. Such accounts have largely
focused on his role as innovator, both of surgical procedures and of medical
informational and illustrative techniques.8 But the inclusion of Usk and the other
London professionals in his patient list suggests that Arderne’s works should be
approached not as the unmediated utterances of a surgical progenitor or innovative
author, but rather with a particular sensitivity to the ways in which they are embedded
in their wider cultural context. Such an approach underscores how local politics,
commerce, surgery and the production of texts converged within the same shifting and
multi-faceted networks in late medieval London; crucially, it allows us to situate
Arderne, as a historical figure within a specific milieu and to see his writings as
operating in close proximity to literary culture.
In this chapter, I analyse the relationship between medical language and the wider
late medieval English culture through a consideration of Arderne’s works. As an author,
he can be seen to have exhibited distinctive traits: his Practica is prefaced by a highly
personalised narrative, remarkable for a surgical treatise; his works include an unusually
detailed programme of practical illustrations, which, with their integral relationship to
the text, appear to have been conceived by him; he incorporated material drawn from
both the European scholastic and the Anglo-Saxon leechbook traditions; his writings,
originally in Latin, were translated into Middle English and widely circulated in
fifteenth-century England. Contemporaneous with Chaucer and John Gower (d.1408),
Arderne’s authorial and professional career coincided with the widespread
8
These comprise the respective emphases by the two historians who have written most
widely on Arderne, D’Arcy Power and Peter Murray Jones. The perspectives of both
authors are described in detail below.
65
vernacularisation of different genres of writing and their increased circulation; the
subsequent translations of his own works meant that they participated in this
development. As with Chaucer, there is no record of Arderne having attended
university, yet there is ample evidence in his texts of his reading of the prominent
classical, Arabic and European medical authorities, as well as Boethius and the Bible. In
this sense, his oeuvre, with its combination of idiosyncratic and traditional elements, its
assemblages of authoritative passages mingling with its tailored case histories, is rooted
in the heterogeneity characteristic of the miscellany; the subsequent incorporation of his
own works in such volumes bespeaks their encapsulation in this tradition.
Arderne’s corpus thus provides an exemplary model through which to begin to
examine the discursive appropriation of medical language in late medieval English
culture. I undertake readings of his language and illustrations to identify their
metaphorical range, moral underpinnings and authoritative postures. In doing so, I
consider his writings in the context of late medieval pietistic and didactic modes.
Through exploring his establishment of a narrative persona, I offer a critique of much of
what has been written about Arderne by medical historians and offer a perspective that
situates him and his works within their historical and cultural context.
Surgery and Surgeon-Authors in late Medieval England
The power struggles that Arderne’s merchant patients seem to have engaged in were
also a feature of the professional lives of contemporary surgeons who sought to
establish themselves as legitimate medical practitioners. English surgeons did not
typically study at university, as elite physicians did, but instead ‘acquired their training
66
through the rigorous system of apprenticeship adopted by all artisan guilds’.9 An
apprentice could spend between five and six years working under a master who
maintained his livelihood and education.10 Such training was part of a wider tendency
towards organisation and professionalisation, including the establishment of a system of
licensing, on the part of both trained surgeons and university educated physicians in the
fourteenth and fifteenth centuries.11 These changes took place amidst greater demand by
noble patients for surgeons and increased public confidence in their abilities. Most
tellingly, the London surgeon, Thomas Morstede (d.1450), was contracted, along with
three others, to accompany Henry V on his French campaigns in 1415.12
Another aspect of this professionalisation was the formation of surgical craft
guilds in London in the fourteenth century, as a way of controlling trades and creating
greater social responsibility amongst practitioners: ‘a fraternity of barbers is mentioned
in 1308 and a fellowship or fraternity of surgeons was in existence before 1369, and a
seesaw struggle between them to exercise control under the gild was long and bitter’.13
The formation of the surgeons’ guild had the aim of attaining professional status for
surgeons and to overcome the general perception of them as craftsmen or tradesmen. 14
9
Rawcliffe, Medicine and Society, p.126.
10
Rawcliffe, Medicine and Society, p.126.
11
Robert Gottfried, Doctors and Medicine in Medieval England 1340-1530 (Princeton,
NJ: Princeton University Press, 1986) pp.265-6.
12
Getz, ‘Faculty of Medicine’, p.393.
13
Richard Theodore Beck, The Cutting Edge: Early History of the Surgeons of London
(London: Humphries, 1974), p.42.
14
Beck, Cutting Edge, pp.120-1.
67
They struggled not only with their social and professional ‘inferiors’, the barbersurgeons and other healers, but also with university-trained physicians. However, a
Conjoint College of Physicians and Surgeons was set up in London in 1423 to gain a
monopoly on professional medical treatment over the barber-surgeons and to attempt to
control the variety of healer-types, or empirics, who possessed neither formal training
nor qualifications. Although it seems to have held some authority for a time, and even
allowed the poor to petition it for free treatment, the college appears to have dissipated
by the end of 1424.15 In the same year, a petition was granted by the lord mayor, John
Mitchell (Morstede’s father-in-law) to the powerful barber-surgeons giving them ‘the
same control over the craft of surgery as they had had before the founding of the
college’.16
The proliferation of surgical treatises that occurred in the fourteenth and fifteenth
centuries can be seen, then, as not only answering a demand for medical knowledge
among readers, but also as providing a vehicle for the legitimacy and authority of
authors like Arderne.17 The earlier works of this period comprised Latin compendia of
the works of Galen and Hippocrates, the Arabic authors, as well as the more
contemporary continental authors such as Henri de Mondeville (c.1260-1316), Guy de
Chauliac, Lanfranc of Milan and others. However, by the late fourteenth century, these
were accompanied by English translations and compilations in alignment with the
appetite for vernacular material in the wider culture; indeed, scholastic medical works
were chief among the first substantial body of Latin writings to be translated into
15
Getz, ‘Faculty of Medicine’, p.402.
16
Getz, ‘Faculty of Medicine’, p.403.
17
Siraisi, Medieval and Early Renaissance Medicine, p.162.
68
English in the fourteenth and fifteenth centuries.18 The burgeoning interest in English
surgical material can be understood by the rise in numbers of non-scholastic, yet literate
and increasingly wealthy, practitioners who provided a market for such books; however,
as I demonstrate below, this interest in medical and surgical works was shared by a
domestic and aristocratic readership including both women and men.
John Arderne was one of a number of English medical authors or compilers
producing texts for a largely lay readership in the fourteenth and fifteenth centuries. He
was born in 1307/08 and practiced surgery in the town of Newark-on-Trent in
Nottinghamshire from the year 1349 until 1370. He then migrated to London where he
continued his practice until his death at some time after 1377. His writings, which he
18
See Linda Ehrsam Voigts, ‘Medical Prose’, in Middle English Prose: A Critical
Guide to Major Authors and Genres, ed. by A.S.G. Edwards (New Brunswick, NJ:
Rutgers University Press, 1984), pp.315-35 (p.327). See also Beck, Cutting Edge,
pp.32-3. The increase in vernacular writings at this time in England can be connected
with the rise of a wealthy merchant class and a corresponding political will to establish
a language that reflected its members’ prestige, and provided a basis for the
development of an English nationalistic culture. See Rita Copeland, Rhetoric,
Hermeneutics and Translation in the later Middle Ages: Academic Traditions and
Vernacular Texts (Cambridge and New York: Cambridge University Press, 1991);
Alastair Minnis, Medieval Theory of Authorship: Scholastic Literary Attitudes in the
later Middle Ages (Aldershot: Scolar, 1988); Fiona Somerset and Nicholas Watson,
eds., The Vulgar Tongue: Medieval and Postmedieval Vernacularity (University Park:
PA: Pennsylvania State University Press, 2003); D.A. Trotter, Multilingualism in Later
Medieval Britain (Cambridge: D.S. Brewer, 2000).
69
appears to have undertaken towards the end of his life, include recipes, case histories
and treatises on various ailments, most notably his Practica de Fistula-in-ano written,
by his own account, in 1376.19 The Practica begins with a brief autobiographical outline
before going on to describe recognition and treatment of anal fistula, or fistula-in-ano, a
painful condition involving the formation of abscesses around the anus.20 His work
shares common formulaic features with his contemporaries. They include: the London
surgeon John Bradmore (d.1412); 21 the anonymous author of a 1392 surgical treatise,
London, Wellcome Historical Medical Library MS 564; the chaplain of St.
19
Biographical information is given in a number of Arderne’s writings. For his birth
date, see De Cura Oculorum, (London, BL Sloane MS 75, f.146) printed in R.Rutson
James, Studies in the History of Ophthalmology in England prior to the year 1800
(Cambridge: Cambridge University Press, 1933), pp.42-6 and 247-52. For information
and dates of his practice in Newark and London, see Arderne, Treatises, p.1. Some
versions of the Practica refer to its year of composition as coinciding with the death of
Edward, the Black Prince (1330-76). See, for instance, London, BL MS Sloane 56, f.74.
20
The condition involves the formation of a tract, usually resulting from bacterial
infection, between the rectum and the area of skin surrounding the anus. Whilst it is not
usually life-threatening today, the greater risk of infection in open sores in the Middle
Ages possibly accounts for the fact that it was regarded as such then. Although
historians have attributed the apparent prevalence of this condition in the Middle Ages
to long, cold and wet hours spent on horseback, this remains speculative. See, for
instance, D’Arcy Power, ‘Introduction’, in Treatises, p.xv.
21
For information on Bradmore, see S. J. Lang, ‘John Bradmore and his Book
Philomena’, Social History of Medicine, 5 (1992), 121–30 and ‘John Bradmore’,
ODNB, http://www.oxforddnb.com/view/article/45759 [accessed 8 Dec 2014].
70
Bartholomew’s Hospital in Smithfield, John of Mirfield (d.1407); 22 and two compilers
and owners of more general medical treatises, Thomas Fayreford (fl.1400-1450) and
John Crophill (d. in or after 1485).23 Additionally, the late medieval period also saw the
22
Although John of Mirfield professes to be a compiler of scholastic material, there are
many sections in his text that are redolent of folk medicine. See Brevarium
Bartholomei, in Johannes de Mirfield of St. Bartholomew’s, Smithfield: His Life and
Works, ed. by Percival Horton-Smith Hartley and Harold Richard Aldridge (Cambridge:
Cambridge University Press, 1936), pp.46-95 (especially, pp.66-9 and pp.86-87). For
more on John of Mirfield, see Carol Rawcliffe, ‘Hospitals of Later Medieval London’,
pp.1–21.
23
Both Fayreford’s and Crophill’s books are held at the British library: they are,
respectively, London, BL Harley MS 2558 and London, BL Harley MS 1735. For more
on Fayreford, see Peter Murray Jones, ‘Thomas Fayreford: An English FifteenthCentury Medical Practitioner’, in Medicine from the Black Death to the French Disease,
ed. by Luis García Ballester, Roger French, Jon Arrizabalaga and Andrew Cunningham
(Aldershot: Ashgate, 1998), pp.156–83, and ‘Harley MS 2558: A Fifteenth-Century
Medical Commonplace Book’, in Manuscript Sources of Medieval Medicine: A Book of
Essays, ed. by M. R. Schleissner (New York: Garland, 1995), pp.35–54. For
information on Crophill, see Peter Murray Jones, ‘John Crophill’, ODNB
http://www.oxforddnb.com/view/article/6780 [accessed 8 December 2014]; L. G.
Ayoub, ‘John Crophill's Books: An Edition of British Library MS Harley 1735’
(unpublished doctoral dissertation, Centre for Medieval Studies, University of Toronto,
1994); E. W. Talbert, ‘The Notebook of a Fifteenth-Century Practising Physician, Texas
Studies in English, 22 (1942), 5–30; R. H. Robbins, ‘John Crophill's Ale-Pots’, Review
of English Studies, 20 (1969),181–9.
71
production of Middle English translations by Mondeville, Chauliac and Lanfranc. These
compilations, translations and newer works typically adopt the traditional model of
addressing a fellow practitioner or apprentice reader and proceeding with the
identification of different illnesses and injuries followed by their treatment.
With the exception of the more personal compilations of Fayreford and Crophill,
the English surgical treatises follow their continental precursors by the inclusion of a
preface with a deontological section, affirming the qualities of the ideal surgeon. This
tends to include standard advice, sometimes excerpted or adapted from the earlier
European scholastic works, although, in some cases, interspersed with original
statements from the author or compiler. The advice typically concerns the practitioner’s
hygiene, his professional integrity and discretion, his behaviour in the houses of his
patients and his learning and skill. 24 Therefore, Arderne follows Lanfranc’s insistence
24
Discussion of ethical responsibilities in medicine is rooted in the Hippocratic corpus
and the writings of Galen, which emphasised cordiality and equanimity between the
practitioner and patient, as well as the importance of the physician acting with propriety
when interacting with his patients and their households. See Carlos R. Galvao-Sobrinho,
‘Hippocratic Ideals, Medical Ethics, and the Practice of Medicine in the Early Middle
Ages: The Legacy of the Hippocratic Oath’, Journal of the History of Medicine and
Allied Sciences, 51:4 (1996), 438-55; Paul Carrick, Medical Ethics in the Ancient World
(Washington: Georgetown University Press, 2001), pp. 83-105. The rise of scholastic
medicine in twelfth-century Europe, along with concomitant efforts to validate the
professional and moral authority of medical practitioners, gave a renewed importance to
deontology in the later Middle Ages. See Michael McVaugh, ‘Bedside Manners in the
Middle Ages’, Bulletin of the History of Medicine, 71:2 (1997), 201-23; Mary Catherine
72
that the surgeon should possess clean and well-shaped hands, and that he should adopt
good manners and much circumspection when visting his patients.25 Similarly, the
anonymous writer of the 1392 surgical treatise borrows from Lanfranc, as well as the
Arab authors, Rhazes (860-c.923) and Avicenna, to insist that the surgeon should be
well-proportioned and possess a temperate complexion, ‘and his body not quakynge,
and al his body able to fulfillen gode werkis of his soule’; additionally, he is required to
have knowledge of all aspects of science, philosophy and scripture.26
Welborn, ‘The Long Tradition: A Study in Fourteenth-Century Medical Deontology’, in
Medieval and Historiographical Essays in Honour of James Westfall Thompson
(Chicago: University of Chicago Press, 1938), pp.344-60; Luis García -Ballester,
‘Medical Ethics in Transition in the Latin Medicine of the Thirteenth and Fourteenth
Centuries: New Perspectives on the Physician-Patient Relationship and the Doctor’s
Fee’, in Doctors and Ethics: The Earlier Historical Setting of Professional Ethics, ed.
by Andrew Wear, Roger K. French and Johanna Geyer-Kordesch (Amsterdam and New
York: Rodopi, 1993), pp.38-71.
25
See Arderne, Treatises, p.6, and Giovanni Lanfranco, Lanfrank’s “Science of
Cirurgie”’, EETS o.s. no.102 (London: Published for the Early English Text Society by
Kegan Paul, Trench, Trübner and Co., 1894), p.6.
26
London, Wellcome Historical Medical Library MS 564, f.57. This manuscript
includes the text from the anonymous London surgeon, which comprises material
adapted from scholastic texts, and part of a treatise by Henri de Mondeville. The
manuscript has been edited by Richard Grothe; see Grothe, ed., ‘Le ms. Wellcome 564:
Deux Traites de Chirurgie en Moyen-Anglais’ (unpublished doctoral dissertation,
University of Montreal, 1982).
73
The interest in the moral qualities of the surgeon extends, for both Arderne and
his contemporaries, to an emphasis on the spiritual and edifying aspects of their own
works. The much repeated motif of invoking God as inspiration behind the surgical
work is usually adhered to, and it is often employed as a means to shore up the
legitimacy of the author and his text. Arderne, for instance, calls upon God to assert the
veracity of his text: ‘Oure lord Ihesu y-blessid God knoweth that I lye not, and therfore
no man dout of this’.27 Distinctively, John of Mirfield, in his Latin treatise Breviarium
Bartholomei, justifies his act of writing a compendium, despite his lack of surgical
expertise, by proposing that his book should help him and other followers of Christ
from imposters who would diagnose their illnesses incorrectly.28
An early fifteenth-century Middle English translation of John Bradmore’s treatise,
called the Philomena, shows how he evinces a similar interest in promoting his work in
moral opposition to the degraded ones it circulates amongst:
Ryght as betwyx wheter & darnell whyll þe erbes be grene and schewes not
schape of þe erys, than ys ther so gret lyknes in þe erbe that þe darnell fro þe
whete may not be dysseveryd, but whan þe erbe of whet aperyth than may þe
darnell opynly be knowyn well inowgh fro þe whet […]. And for that nowadays
in surgery þe darnell of arror with þe whete of trewth growys to gedyr amonge
full sympyll letteryd men, sum be fantysyd […] in diverse ynolysch bokys and for
the gret lyknes þat ys be twyne þe grene whete & þe darnell be for þe herynge
dyscrescioun may not be gyffyn be twex them as longe as thei be hyd undyr the
color of ynnoraunce.29
27
Arderne, Treatises, p.2.
28
John of Mirfield, Brevarium Bartholomei, pp.48-51.
29
See London, BL Harley MS 1736, f.6. Printed in Beck, Cutting Edge, pp.107-8.
Although it is now generally agreed that Bradmore authored the Philomena, Beck
attributes it to Bradmore’s contemporary, Thomas Morstede. For the argument
proposing Bradmore as author, see Lang, ‘John Bradmore’, pp.121–30. The Latin
74
In this highly original introduction to a surgical treatise, the contrast between authentic
and false surgical knowledge is given divine weight with a metaphor borrowed from the
gospels (Matthew 13:27) where Jesus compares the separation of good from evil to that
of wheat and weeds.30 But it is the increase and diversity of English books ‘nowadays’
that fuels the author’s concern of the ability of ‘sympyll letteryd men’ to distinguish
between authentic and false books. Bradmore wishes to resolve this crisis so that:
Þe eyrys of þe whet of trewth may be mad opyne be þe knowlege of þe
pryncypylles of this crafte of surgery. Wherfor to þe worschype of all myghty
gode […] to þe prophete of all crysten pepull […], I have compylyd & made this
boke.31
The Middle English pun on wheat/human ears evokes the reader’s discernment which,
the author suggests, can be fostered through the correct transmission of the ‘truth’
gleaned from the medical authorities, as expounded in the Philomena. By employing the
wheat-and-weeds metaphor, Bradmore situates surgical writing within the broader realm
of moral veracity. This is achieved through the biblical resonances of the metaphor, but
also in relation to more contemporary heretical discourse: the imagery, in the
Philomena, of violently expelling false knowledge - that ‘þe darnell of Error be pullyd
original of the Philomena survives in London, BL Sloane MS 2272 and some extracts
are also in Oxford, All Souls College MS 73.
30
The image of the separation of grain from weeds or chaff was a common proverbial
one in Middle English writings. For examples, see Bartlett Jere Whiting, Proverbs,
Sentences and Proverbial Phrases: From English Writings mainly before 1500
(Cambridge, Mass. and London: Belknap Press, 1968), pp.98-99.
31
Harley MS 1736, f.6.
75
owt be þe rote and castyn away’ – resonates with much anti-Lollard literature.32 Paul
Strohm has shown how the word ‘lollard’ itself (applied to the followers of religious
reformer, John Wyclif (d.1384)), was often linked to the Latin word for cockle or tare,
lolium or lollium, although it is etymologically rooted in continental anti-heretical
discourse.33
That the opening comments of a surgical work should be invested with such
freighted metaphors not only points to the self-legitimising efforts of English medical
writers, but suggests that surgical language was not immune to apprehensions of
heretical ideas; this can only have been heightened in the wake of Arundel’s
‘Constitutions’ of 1409, implemented to prevent the spreading of heretical ideas in
books, with a particular focus on curbing vernacular writings.34 Bradmore’s imagery,
through stressing the need to uproot and destroy erroneous writings, and by proclaiming
the adherence to tradition as a signifier of truth, underscores the moral stakes involved
in the production of surgical literature.
However, it is this idea of a homogeneous, intact tradition encompassing the
transmission of medical knowledge that the writings of John Arderne seem to rub
32
Harley MS 1736, f.6.
33
See Paul Strohm, Theory and the Premodern Text (Minneapolis: University of
Minnesota Press, 2000).
34
See Nicholas Watson, ‘Censorship and Cultural Change in Late-Medieval England:
Vernacular Theology, the Oxford Translation Debate and Arundel’s Constitutions of
1409’, Speculum, 70 (1995), 822-64, and James Simpson, The Oxford English Literary
History, 1350-1547: Reform and Cultural Revolution, Vol. II (Oxford: Oxford
University Press, 2002), pp.458-501.
76
against, and this is one way in which his work can be distinguished from that of his
contemporaries. Even though Arderne, like Bradmore and John of Mirfield, asserts his
orthodox credentials by insisting on a divine mandate for his own writings, he does
resist, to an extent, the idea of the principals of surgery emerging whole from his
forbears. Certainly, the manuscripts that bear his work undermine the traditional headto-toe organisation of the surgical treatise. His Practica is unusually limited to a
consideration of anal fistula, along with a few other conditions, and it eschews the usual
divisions or section headings typically found in surgical texts.35 Arderne’s other
writings appear as fragments throughout the various manuscripts they are located in,
and they cannot be assembled to produce a coherent whole.36 The multiple personal case
histories randomly scattered throughout his writings again bespeak an author who is as
much concerned with establishing personal narratives as deferring to the sayings and
writings of his auctoures. His stories are notable for their references to specific places
(usually at or near Newark and London) and events, such as his reference at the
beginning of the Practica to the Black Death.37 Whilst his contemporaries did include
35
Peter Murray Jones, ‘John of Arderne and the Mediterranean Tradition of Scholastic
Medicine’, in Practical Medicine from Salerno to the Black Death, ed. by Luis García
Ballester, Roger French, Jon Arrizabalaga and Andrew Cunningham (New York and
Cambridge: Cambridge University Press, 1994), pp.289-321 (pp.306-7). As Jones
points out, none of the earliest extant manuscripts containing the Practica show much in
the way of separate chapters or sections.
36
Peter Murray Jones, ‘Four Middle English Translations of John of Arderne’, in
Latin and Vernacular: Studies in Late-Medieval Texts and Manuscripts, ed. by A.J.
Minnis (Cambridge: D.S. Brewer, 1989), pp.61-89 (p.66).
37
Arderne, Treatises, p.1.
77
personal anecdotes in their works – Bradmore, for instance, writes about his treatment
of Henry, Prince of Wales (later Henry V) for an arrow lodged in his cheekbone
received at the battle of Shrewsbury, 1403 - they appear with far more frequency in
Arderne’s writings.38
It is the cultivation of a narrative persona in Arderne’s writings that distinguishes
them most from other medical writings, and aligns them more with the narrative
techniques of late medieval poets and literary writers. He establishes an
autobiographical register in the first lines of the Practica: ‘I, Iohn Arderne fro the first
pestilence that was in the ȝere of oure lord 1349 duellid in Newerk in Notyngham-shire
vnto the ȝere of oure lord 1370, and ther I helid many men of fistula in ano’.39 This
testimony is followed with an itinerary of the names and occupations of the elite
patients he cured in Newark and London, and of his development of the cure for anal
fistula. The narrative foregrounds Arderne’s personal experience and insists on the
importance of his practice-based knowledge in the establishment of an effective cure for
the condition (in opposition to one that is purely theoretical or gleaned from the writings
of others).
The kind of author presented here is, in many ways, one that is not too distant
from a modern view of the author as a single, gifted or wise subject who imparts
knowledge, and even (vicarious) experience, to the reader. Yet, in other respects,
Arderne also fits the model of the medieval author, liberally interspersing his work with
the quotations of classical and Arabic medical writers, philosophers and Scripture. He
38
On Bradmore’s treatment of Henry V, see BL Harley MS 1736, f.48v. See also Beck,
Cutting Edge, p.117.
39
Arderne, Treatises, p.1.
78
navigates between acknowledging the tradition he is working within and affirming his
own innovations and skills. Indeed, this strategy can be seen in relation to contemporary
late medieval developments of the idea of the author. A.J. Minnis has analysed how
fourteenth-century English literary authors, like Gower and Chaucer, displayed an
awareness of the ‘role of the auctor and of the literary forms which should be their
models’, but then used this awareness to ‘manipulate [such] conventions […] for [their]
own literary ends’.40 This can be seen in Chaucer’s authorial disavowals in The
Canterbury Tales and Troilus and Criseyde where the author is imagined as a mere
vehicle through which a story, rooted in classical or biblical tradition, passes.41 Yet, the
disavowal of authorial intent is precisely what establishes the authorial voice. The
rhetoric of truth-telling is established in order to create an ironic distance between the
narrative and the reader’s reception of it: ‘it is this knowing fiction of authorial modesty
40
A.J. Minnis, Medieval Theory of Authorship, p.210. This authorial self-awareness was
mediated by the fact that the named author was, along with scribes, illustrators,
commentators and commissioners, just one possible producer of a text. On St.
Bonaventure’s (1221-74) taxonomy of book producers see Minnis, Medieval Theory of
Authorship, pp.94-5. See also John Burrow, Medieval Writers and their Work: Middle
English Literature and its Background 1100-1500 (Oxford and New York: Oxford
University Press, 1982), pp.29-30; Stephanie Trigg, Congenial Souls: Reading Chaucer,
Medieval to Postmodern (Minneapolis: University of Minnesota Press, 2002), pp.40-73;
Anthony Bale, ‘From Translator to Laureate: Imagining the Medieval Author’,
Literature Compass, 5:5 (2008), 918–934.
41
See, for instance, ‘General Prologue’, The Canterbury Tales, RC, I, lines 723-46 and
Troilus and Criseyde, RC, Book I, lines 393-5 and Book V, 1050.
79
that allows us to recognise the elaborate authorial game that is set in motion in The
Canterbury Tales’.42
Arderne engages in a similar authorial strategy of calling up the tradition he is
working within as a way to subvert it rhetorically. In advancing a claim that he has
discovered an effective treatment for anal fistula, he hesitates between an
acknowledgement of his forbears and an affirmation of his innovation.43 Following his
detailing of the patients he has cured of the condition, he goes on:
All thise forseid cured I afore the makyng of this boke. Oure lord Ihesu y-blessid
God knoweth that I lye not, and therfore no man dout of this, þof-al old famous
men and ful clere in studie haue confessed tham that thei fande nat the wey of
curacion in this case. ffor god, that is deler or rewarder of wisdom, hath hid many
thingis fro wise men and sliȝe whiche he vouchesaf aftirward for to shewe to
symple men.44
Arderne has succeeded in establishing a cure where, it seems, the best and wisest
surgeons before him failed. In a sense, this might be a risky assertion given that he
foregoes the trope of humility and the traditional authorial imperative of deferring to
one’s predecessors. But he appeals to the higher authority of God – ‘deler or rewarder of
wisdom’ – who, he claims, has reversed the standard hierarchies and entrusted the
42
Andrew Bennett, The Author (Abingdon and New York: Routledge, 2005), p.42.
43
Despite this claim, Arderne’s method of treating anal fistula by cutting through the
fistula tract is, in fact, discussed in many treatises extending back to antiquity. Plinio
Prioreschi claims that Arderne’s innovations included the introduction of an eyed probe
and peg to tighten the ligature used for cutting, as well as the application of mild agents
instead of caustics as aftercare. See Prioreschi, History of Medicine, pp.509-12.
44
Arderne, Treatises, p.2.
80
responsibility of finding a cure to the simple man, Arderne. There is here the faint
implication that the failure of the medical scholastics is as much a moral error as a
professional one.Thus, the wise men have had to confess that they have failed to find
‘the wey of curacion’, where ‘the wey’ evokes the specialised metaphor in biblical
language of Christ as the path and means to salvation. The appropriation of this
language offers Arderne a means of assuming both the humility proper to an author and
the professional authority of a surgeon, one that allows him to assert his veracity
through the universal command that ‘therfore no man dout of this’.
Therefore, whilst Arderne is very much embedded in late medieval medical
culture through his elucidation of surgical techniques and procedures (and claims to
moral authority), his resistance to authoritative deferral distinguishes him from other
contemporary medical and surgical writers. His introductory personal testimony and
case histories, interspersed with a liberal use of classical and scriptural quotations, along
with his undermining of the old masters, shows how he sets up an idea of himself as his
own auctour. This allows us to situate his writings in close proximity to late medieval
developments where the image of the author deferring to his scriptural and classical
forbears, and posing himself as compiler of the works of others, was gradually giving
way to the idea of author as originator and creator.45
45
See Minnis, Medieval Theory of Authorship, pp.160-210.
81
The Critical Inheritance of Arderne and the Practica de fistula in ano
Given the constructed nature of the authorial persona in Arderne’s writings, as well as
their investments in topoi of both humility and authority, it is instructive to note how
such enunciations have informed his profile since the nineteenth century. Arderne’s
claim of being the first to have found an effective cure for anal fistula, along with his
case histories, featuring his successful cures of noble patients, have been taken at face
value to contribute to his status as England’s ‘first great surgeon’ or, to quote the title of
a 1956 article, the ‘father of English surgery’.46 The articulation of Arderne in terms of
a hegemonic, nationalistic discourse is reflected in Peter Murray Jones’s reference to
Arderne’s emphasis on anal conditions, lamenting that ‘it is perhaps a pity that the name
of the greatest English medieval surgeon should be associated with an operation which
seems so undignified’.47 Historians have constructed a biography for Arderne, in
keeping with his status as a great surgeon, by supplementing his skeletal
autobiographical references with extra detail.48 Such suppositions, through repetition in
46
Gerald N. Weiss, ‘John of Arderne: Father of English Surgery’, The Journal of the
International College of Surgeons, 25:2 (1956), 247-61.
47
Peter Murray Jones, Medieval Medicine in Illuminated Manuscripts (London: British
Library, 1998), p.91.
48
Although the name Arderne is a common one in late medieval official documents,
Peter Murray Jones finds ‘no good reason for connecting him to any of the other John
Ardernes met with in contemporary documents, or for linking him to any particular
family of Ardernes’. See Jones, ‘Staying with the Programme: Illustrated Mansucripts
of John of Arderne, c.1380-c.1550’, in English Manuscript Studies 1100-1700:
82
various histories and encyclopaedic entries, have congealed as facts and retain their
currency.49 Many of these claims – his experience as a military-surgeon in the Hundred
Years’ War, his attachment to the household of John of Gaunt, his membership of a
London surgeons’ guild – can be traced to the work of D’Arcy Power, an antiquarian
and surgeon at St. Bartholomew’s hospital in London. In 1910, Power produced the
first, and (to date) the only, complete printed edition of Arderne’s Practica, and he
wrote extensively on Arderne’s life and work.50
Power’s claim that Arderne was a military-surgeon is based on the opening
passage of the Practica where Arderne asserts that, dwelling in Newark from the year of
the ‘pestilence’, or Black Death, 1349, he cured the anal fistulae of many men, ‘of
Decoration and Illustration in Medieval English Manuscripts, ed. by Peter Beal and
Jeremy Griffiths, Vol. X (Oxford: Blackwell, 2002), pp.204-36 (p.206).
49
See, for instance, the encyclopaedic work by Jack E. McCallum, Military Medicine:
From Ancient Times to the 21st Century (Santa Barbara: ABC-Clio, 2008), p.174; Leo
M. Zimmerman and Ilza Veith, Great Ideas in the History of Surgery (Baltimore:
Williams and Wilkins, 1961), pp.158-63; Weiss, ‘Father of English Surgery’, pp.24761.
50
Power edited the Practica from extracts from two fourteenth-century English
translations of Arderne’s Latin work found in London, BL Sloane MS 6 and BL Sloane
MS 277. He also attempted to classify Arderne’s corpus in ‘The Lesser Writings of John
Arderne: Read at the Seventeenth International Congress of Medicine, London, August
1913’, History of Medicine, 23 (1913), 107-33, and ‘Epoch-Making Books in British
Surgery: “A System of Surgery” by Master John Arderne’, The British Journal of
Surgery, 15:57 (1927), pp.1-9.
83
whiche the first was Sire Adam Eueryngham [who] was in Gascone with sir Henry, that
tyme named Erle of derby and aftir was made duke of lancastre, a noble and worthi
lord’.51 This appears to refer to the Gascon campaigns of Henry of Grosmont (c.131061), first Duke of Lancaster, which took place during 1345-7, part of the long series of
battles between England and France usually referred to as the Hundred Years’ War.
Arderne’s account goes on:
The forsaid sir Adam, forsoth, suffrand fistulam in ano, made for to aske counsel
at all the lecheȝ and cirurgienȝ that he myȝt fynde in Gascone, at Burdeux, at
Briggerac, Tolows, and Neyrbon, and Peyters, and many other places. And all
forsoke hym for vncurable; whiche y-se and y-herde, þe forseid Adam hastied for
to torne hom to his contre. […] At laste I, forseid Iohn Arderne, y-souȝt and
couenant y-made, come to hym and did my cure to hym.52
Power claims this as proof of Arderne’s involvement in these wars, not only because of
his cure of the sick knight, but also because Arderne lists the towns of southern France
in the order in which they were reached by the invading English army.53 However,
Arderne does not state that he was present at any of these battles; in any case, as the
narrative indicates, it is not until Sir Adam returns home that he is cured by Arderne.54
Arderne could have been told of these facts or read about them in a chronicle.
51
Arderne, Treatises, p.1.
52
Arderne, Treatises, p.1.
53
Power, ‘Introduction’, in Treatises, p.xi.
54
For a comprehensive critique of this and other claims made by Power about Arderne,
see Huling Ussery, Chaucer's Physician: Medicine and Literature in FourteenthCentury England (New Orleans: Tulane, 1971), pp.63-7.
84
Power’s biographical outline continues by shading in Arderne’s life prior to
1349.55 Despite lack of evidence, he places him in France with Henry of Grosmont as
his surgeon and claims that, afterwards, Arderne was attached to the household of
Henry’s son-in-law, John of Gaunt (notwithstanding the absence of reference to Arderne
in John of Gaunt’s household register).56 Power goes on to speculate about Arderne’s
return to England in 1349, suggesting that the reason was ‘perhaps because the ravages
of the Black Death caused a temporary cessation of hostilities and compelled the
military surgeons to seek a more peaceful method of gaining a livelihood’.57 He also
claims that when Arderne arrived in London in 1370, he became a member of the Guild
of Surgeons, again, a claim neither proposed by Arderne nor backed up with evidence
from other documents.
The type of biography that D’Arcy Power constructs for Arderne is in keeping
with attempts by early historians of medicine and antiquarians to define the lives of the
‘great men’ of science and medicine in accordance with values that stressed their
singularity and achievements. Such glorification aligns with the grand narrative of
medicine’s (and civilisation’s) progress through the ages, commonplace amongst
55
This biographical narrative is succinctly outlined in Power, ‘Lesser Writings’,
pp.107-8.
56
Ussery points out that Arderne, a writer disposed to mention his connections with
great men, never claims an association with John of Gaunt himself. He questions ideas
that Arderne and Chaucer were connected through John of Gaunt. See Chaucer’s
Physician, p.63.
57
Power, ‘Lesser Writings’, p.108.
85
historians of the nineteenth and early twentieth centuries.58 Although Power configures
the Middle Ages in terms of ignorance and superstition, Arderne, as a ‘great man’, is
seen to transcend such limitations. Instead, Power views him as the figurehead or
originator of a genealogy of great English surgeons: ‘the distinguishing mark of each
was the possession of the qualities which make an English gentleman as well as a fine
surgeon. They were all men of good education, wide experience and sound judgement.
John Arderne possessed these qualities in abundance’.59
After stripping away these superfluous ‘facts’ of Arderne’s life, and their
Edwardian-period gloss, we are left with the stark information of significant events in
Arderne’s life, mentioned in his works (the years of his birth, the Black Death, his
practice in Newark and his move to London), and more detailed accounts of his practice
including his patients, their illnesses and his superlative cures. Nonetheless, the
inclusion of such details, particularly of his elite patients and their martial careers, does
encourage us to think of Arderne (and, by extension, the late medieval English surgeon)
as a figure concerned with social hierarchy and the cultivation of professional networks.
In this sense, his narratives not only indicate the type of patients he might have treated
or mixed with; they also reveal an authorial interest in self-validation or promotion, and
perhaps in instigating a readerly frisson, through references to elite personages and the
inclusion of vignettes such as Adam Everingham’s afflicted French odyssey. Arderne’s
role as author is therefore intrinsic to how he should be understood. His connections
with the London merchants, and (possibly) Thomas Usk, indicate his assimilation in late
58
For an overview of this tendency, see Mary Lindemann, Medicine and Society in
Early Modern Europe (Cambridge: Cambridge University Press, 2010), pp.1-6.
59
Power, ‘Introduction’ in Treatises, p.xiv.
86
medieval textual culture; the references in his works to philosophical, as well as
medical, authorities also place him in this milieu.
To what extent can Arderne, as author, be seen as part of a medical scholastic
orthodoxy? One of Power’s titles for Arderne’s collection of treatises, ‘A System of
Surgery’, certainly foregrounds their scholastic, rational credentials. Again, this accords
with the patristic view of Arderne as the precursor of modern medicine, or as a kind of
medical analogue to Chaucer. The textual transmission of Arderne’s writings is, in fact,
characterised by disorganisation and instability: his various case histories, medical
recipes and descriptions of treatment cover a variety of conditions, and are typically
presented in fragmented form in his manuscripts. As Jones argues, it is ‘impossible to
reassemble them to make a compendium of practical medicine on the scholastic
model’.60 Thus, whilst they are infused with the language and perspectives of the
European scholastic tradition, they are in contradistinction to its formulaic and
textually-ordered principles.
Although over forty manuscripts of Arderne’s writings have been identified, all of
which include at least some sections of the Practica, Power’s edition is based almost
exclusively on the version in London, BL Sloane MS 6.61 The manuscript, a paper
codex written in a gothic cursive hand, was produced in the second quarter of the
fifteenth century. It represents the most complete Middle English version of the
60
Jones, ‘Mediterranean Tradition’, p.301.
61
Power supplements defective or missing passages with their equivalents in London,
BL Sloane MS 277, the same translation as Sloane MS 6; he also includes a charm,
translated from the Latin in London, BL Sloane MS 2002. See Arderne, Treatises,
pp.20, 26 and 102-3.
87
Practica available, and is given the rubric: ‘A tretis extracte of Maistre Iohn Arden of
fistula in ano and of fistula in oþer placeȝ of þe body’.62 In addition to the Practica, the
manuscript includes various fragmented medical texts in Latin, English, Dutch, German
and French (attributed to Arderne and various other authors including the Arabic writer,
Hunein (c.809-c.873) and Galen). This version of the Practica includes information not
only on anal fistula but also fistulae in other parts of the body, recipes for medical
compounds and Arderne’s case histories, pertaining to a variety of medical conditions.
It is an integral treatise in the sense that it includes a list of contents (which is
subsequently adhered to), but not in terms of its content which does not appear to be
governed by any anatomical or pathological taxonomy (as most scholastic texts are).
If the version of the Practica in Sloane MS 6 (and Power’s edition), with its
random content, is accepted as an integral whole, then it is difficult to justify why it
should be treated separately to the rest of Arderne’s corpus, comprising, as it does, of
similar case histories, medical recipes and descriptions of surgical instruments and
techniques.63 D’Arcy Power has grouped the non-Practica writings (confusingly) under
various titles: the Liber Medicinalium, a System of Surgery and, more simply, the
62
Sloane MS 6, f.141v; reproduced in Arderne, Treatises, pp.xxxvi-xxxvii.
63
Although two texts attributed to Arderne are discrete treatises: a text on
ophthalmology, De Cura Oculorum, dated to 1377 (see James, Ophthalmology, pp.42-6
and 247-52) and the Mirror of Phlebotomy (see Sloane MS 6, f.33-41). However, Jones
argues that the attribution of the Mirror to Arderne is questionable. See Jones,
‘Mediterranean Tradition’, p.301.
88
Lesser Works.64 Power’s distinction between the Practica and the Liber Medicinalium
(the title he most commonly gives to Arderne’s remaining corpus) appears to be based
exclusively upon the integrity of the Practica in Sloane MS 6.65 But the Practica is
often incorporated within the Liber, either wholly or in fragments, in the Arderne
manuscripts.66 For instance, a late fifteenth-century manuscript including Arderne’s
writings, London, BL Sloane MS 76, begins with a discussion of phlebotomy, followed
by haemorrhoids; it then segues, without any distinctive sectional break, into the chapter
of the Practica detailing the operation for the removal of anal fistula (f.19). The text
then follows the order of the Practica (as set out in Sloane MS 6) before it is curtailed
to make way for an unrelated section describing various remedies (f.58). After this, we
find the introduction to the Practica (f.143); this continues for a folio before breaking
off again for more medical recipes, this time in a different hand. This type of fluidity is
typical of the organisation of material in the Arderne manuscripts as a whole.
Peter Murray Jones, in noting the level of disorganisation that the Liber is subject
to, and the difficulty of locating where the Practica has finished in some of its
manuscripts, concludes nevertheless that Power’s distinction between the Practica and
Liber is ‘worth preserving, so long as it is borne in mind that the Practica is often found
within the Liber medicinalium’.67 Conversely, I suggest that the Practica only makes
sense as an integrated text in its opening chapters where Arderne addresses the subject
64
See Power, ‘Lesser Writings’, pp.107-33, and his introduction to Treatises, pp.ix-
xxxv.
65
The full title is the Liber medicinarium sive receptorum liber medicinalium.
66
See Jones, ‘Four Middle English Translations’, p.66.
67
Jones, ‘Four Middle English Translations’, p.66.
89
of anal fistula, as well as the qualities of a good surgeon. Although this sequence is
broken in some manuscripts, it is retained in most, and it possesses enough semantic
unity to be thought of as a coherent text. It may, in this sense, be considered as a
fragment or ‘extracte’ (as it is called in the rubric of Sloane MS 6) alongside the other
various writings attributed to Arderne.68 Whilst we cannot recover how Arderne
envisaged the schematic configurations of his writings, their resistance to coherence
along the lines of any recognisable taxonomy, and their jumbled nature, are more
suggestive of the medical (and more heterogeneous) miscellanies that circulated among
late medieval lay readers.69 Although such miscellanies included a large amount of
scholastic material, this inclusion often entailed the rupturing of its highly coherent
head-to-toe format; it was often blended with non-scholastic or ‘folk’ remedies, as it is
in Arderne’s works. Arderne, as an author who may well have gained some of his
professional knowledge from miscellanies circulating beyond the university environs,
should be aligned more with the culture representative of such texts, than a scholastic
one.
68
Consequently, I refer to the Practica, when discussing these passages, and the Liber
medicinalium, when referring to Arderne’s other writings (with the exception of the
ophthalmology treatise, De cura oculorum).
69
For perspectives on late medieval miscellanies and their circulation, see The Whole
Book: Cultural Perspectives on the Medieval Miscellany, ed. by Stephen G. Nichols and
Siegfried Wenzel (Ann Arbor: The University of Michigan Press, 1996).
90
Programme of Illustrations
Despite the ‘disorganisation’ of Arderne’s corpus, its programme of illustrations
maintains a remarkable consistency in the various manuscripts of his works. Even
though passages and sections may be susceptible to a high degree of variation in the
different manuscript versions of his works, the same marginal illustrations tend to occur
alongside their corresponding case histories or descriptions of treatment in the main
text. This consistency is indicated by the similarity between the set of illustrations found
in the earliest Latin Arderne manuscripts, such as one held at Glasgow University
(Glasgow, Hunterian Museum MS 112), dating from the late fourteenth/early fifteenth
century, and one produced during the sixteenth century (London, BL Sloane MS 776). It
can be explained by the highly functional nature of the illustrations: the majority of
images in the margins of Arderne’s texts serve to explicate, in some way, the text they
accompany.
Although practical medical images (particularly anatomical ones) had been
produced since antiquity, it was only in the twelfth century, and the development of a
separate surgical literature, that images featuring bodily wounds, surgical procedures
and instruments became commonplace in such texts.70 Whilst these images may have
70
On early medical images, see Tibor Doby and George Alker, Origins and
Development of Medical Imaging (Carbondale: Southern Illinois University Press,
1997), pp.1-20. For the production of medical images in medieval Europe from 1200,
see Visualising Medieval Medicine and Natural History, 1250-1550, ed. by Jean A.
Givens, Karen M. Reeds and Alain Touwaide (Aldershot and Burlington, VT: Ashgate,
2006). See also Loren MacKinney, Medical Illustrations in Medieval Manuscripts
91
had a functional nature, their presence in some manuscripts seems to have had as much
to do with courtly patronage as with scholastic requirements.71 The illustrations in
Arderne’s manuscripts are distinctive in a number of ways. First, there is an integral
relationship between images and text, demonstrated by the way the text often references
the marginal images (with the words ‘sicut hic depingitur’, or in Middle English, ‘as it
is here depeynted’); for Jones, this suggests that Arderne devised the programme of
illustrations himself. 72 Second, the Arderne manuscripts are heavily illustrated with, in
some cases, more than a hundred images. Finally, the assortment of images including
body parts, surgical instruments, decorative clothing, plants and animals are unique for
a surgical text.
The illustrations can be categorised according to three types: there are drawings
that demonstrate the stages of the operation for the removal of anal fistula; there are
images meant to help the reader visualise or memorise particular case histories, recipes
or descriptions of treatment referred to in the text (these include images of patients
showing their diseased body part); some of the manuscripts include illustrations of
figures outlining the body’s blood vessels or pathways of the nerves (images that had a
wide currency in medical and other writings). The illustrations detailing the stages of
(London: Wellcome Historical Medical Library, 1965), and Jones, Illuminated
Manuscripts.
71
For discussion of an example of this, see Cathleen Hoeniger, ‘The Illuminated
Tacuinum sanitatis Manuscripts from Northern Italy, ca. 1380-1400: Sources, Patrons
and the Creation of a New Pictorial Genre’, in Visualising Medieval Medicine, ed. by
Givens et al., pp.51-82.
72
Jones, ‘Staying with the Programme’, p.205.
92
the operation, which tend to be the largest of all the images, usually include the display
of the instruments involved in the operation accompanied by images showing how they
are to be applied to the patient’s lower body. The drawings of patients next to their
descriptions in Arderne’s case histories follow a more varied pattern. The cases range
from descriptions of swollen legs and embedded objects to genital diseases, as well as
anal fistula. In the case of anal fistula, the lower torso of the patient’s body, revealing its
fistula holes, is often pictured as if emerging out of the text with its legs dangling in the
margin (fig.1). For other conditions, there are both full-length and partial images of the
patient, often pulling apart her or his clothing to reveal the relevant injury. Furthermore,
there are images that relate to the text in more oblique ways: for example an image of a
gimlet in one manuscript accompanies a description of an intestinal obstruction, the
iliaca passio, because the text mentions that the condition involves a twisting of the guts
as if by a gimlet; in another instance, the story of a soldier cured at Algeciras in Spain is
indexed by a small image of a cityscape.73 Such images, whilst possibly working as
mnemonic aids, impart a sense of diversity and novelty to the text, and encourage the
reader’s attention to the, sometimes, circuitous relationship between text and image.
73
For the gimlet, see London, BL Harley MS 5401, f.17v. The image of Algeciras is in
London, BL Sloane MS 56, f.8. Discussion of these type of images is found in Jones,
‘Staying with the Programme’, pp.213-5, and ‘Image, Word and Medicine in the Middle
Ages’ in Visualising Medieval Medicine, ed. by Givens et al., pp.1-24 (p.14).
93
Fig.1: Anal fistula images. John Arderne’s Liber medicinalium. 1450-1500. London, BL
Harley MS 5401 f.44v
The Stockholm Roll and a Non-Surgical Audience
The inclusion of images that engage with a reader’s sense of fascination or novelty
raises the question as to whether Arderne’s texts are oriented exclusively to a surgical
audience. Although there is a sense, among critics, that Arderne’s texts may have had a
non-surgical readership, the extent to which they might have been read as something
other than a set of illustrative writings for the utilitarian benefit of literate surgeons has
not been considered in depth.74 Indeed, evidence of a practical use is suggested by the
74
However, a growing body of scholarship analyses the ways in which seemingly
diverse medieval works, which have been cordoned into discrete generic categories,
were often produced, located and received in the same cultural milieus: Irma
94
Arderne manuscripts which were owned by barber-surgeons like Charles Whytte
(Sloane MS 776) and Thomas Plawdon (Cambridge, Gonville and Caius College MS
176/97). The blood-coloured stains in the copy of Arderne’s works owned by sixteenthcentury London practitioner, Charles Whytte, particularly in the pages featuring
colourful depictions of the anal fistula operation, hint at the book’s instrumental role.75
But the survival of other expensively produced manuscripts, which include
Arderne’s works, suggests a readership extending beyond a professional coterie of
medical practitioners. This is true of a fifteenth-century manuscript held at the British
Library (London, BL Add MS 29301) in Latin and Middle English, which includes
extensive writings by Arderne, as well as a regimen called the Governayle of Helthe. Its
illuminated borders, delicate illustrations and its production on vellum all suggest a
noble owner. It includes a Middle English text on the virtues of medicinal herbs. The
entry for ‘rosemary’ reads: ‘Rosa Marina is bothe tre and herbe […] as þe clerk seith þat
þis book wrot at scole of Salern to the Countesse of Hennawd, and sche send þe copy to
Taavitsainen has shown how some late medieval scriptoria specialised in producing
both devotional and medical works; Linne Mooney, similarly, has described Chaucer’s
scribe, Adam Pynkhurst working on political and literary texts. See Taavitsainen,
‘Scriptorial “House-Styles” and Discourse Communities’, in Medical and Scientific
Writing, ed. by Irma Taavitsainen and Paivi Pahta, pp.209-40, and Linne Mooney,
‘Chaucer’s Scribe’, Speculum, 81 (2006), 97–138. See also Green, ‘Possibilities of
Literacy’, pp.1-76.
75
London, BL Sloane MS 776, ff.119v -120.
95
here douter, qwen of England’.76 The queen referred to here is Philippa of Hainault
(c.1310-1369), wife of Edward III (1312-1377). Her marriage to Edward arose from the
desire of his mother, Isabella of France (1295-1358), to create an alliance with Hainault,
in the Low Countries, as part of a strategy to install Edward as king.77 Philippa’s
position as queen, achieved in large part through the auspices of her mother, Jeanne de
Valois (c.1294-1342), Countess of Hainault, was marked by her continued fostering of
insular and pan-European alliances. This was accompanied by strong and diverse
literary interests: she was a patron for the poet-minstrel Jehan de la Mote and owned a
number of romance works, as well as a deluxe illuminated manuscript containing a
French translation of the Secreta Secretorum, the Aristotelian treatise on science,
government, devotion and medicine.78 Her ownership of medical works is also attested
76
London, BL Additional MS 29301, f.94. On the significance of rosemary and its
medical properties in the Middle Ages, see George R. Keiser, ‘Rosemary: Not just for
Remembrance’, in Health and Healing from the Medieval Garden, ed. by Peter Dendle
and Alan Touwaide (Woodbridge: Boydell Press, 2008), pp.180-204.
77
See Juliet Vale, ‘Philippa’, ODNB, http://www.oxforddnb.com/view/article/22110
[accessed 20 Oct 2014]; Paul Binski, Westminster Abbey and the Plantagenets:
Kingship and the Representation of Power, 1200–1400 (New Haven and London: Yale
University Press, 1995), pp.179-80.
78
On royal ownership of this text, see Anne Rudloff Stanton, ‘Isabelle of France and
her Manuscripts, 1308-1358’, in Capetian Women, ed. by Kathleen Nolan (New York:
Palgrave Macmillan, 2003), pp.225-52, and Katherine J. Lewis, ‘Edmund of East
Anglia, Henry VI and Ideals of Kingly Masculinity’, in Holiness and Masculinity in the
Middle Ages, ed. by P.H. Cullum and Katherine J. Lewis (Cardiff: University of Wales
Press, 2004), pp.158-73.
96
to in this passage and is further evidence of the commissioning of medical works by
high status noblewomen. It encourages us, in this instance, to view the circulation of
these elite books as concomitant with the manoeuvres and alliances formed between
European royal houses. Although Arderne was writing forty years after the Countess of
Hainault commissioned the herbal treatise, the fact that his writings travel with a copy
of it shows how they would have attracted the same kind of readership.
A fifteenth-century surgical roll held at the National Library of Sweden at
Stockholm (Stockholm, Kungliga Biblioteket MS X.118) provides further compelling
evidence of a non-surgical readership of Arderne’s writings. The seventeen-foot roll,
consisting of six stitched pages of vellum, consists mainly of Arderne’s writings and
includes various cures, charms and anatomical descriptions.79 Written entirely in Latin,
the text begins with the opening words of the Practica, referring to Arderne’s
background in Newark and his move to London, but then suddenly (and typically)
breaks off to outline a remedy for damaged hair. It goes on to detail a variety of
conditions, cures and case histories. Although it is composed of fragmented extracts
from Arderne’s works, unusually the material is (re)ordered to follow, roughly, the
head-to-toe format characteristic of the typical scholastic treatise.
The roll includes lavish and detailed illustrations with polychromatic and pasteltinted figures. These follow the programme of illustrations in Arderne’s wider corpus:
they include images of the anal fistula operation, those linked to case histories and
treatment, as well as the Blood Vessel and Nerve Men; in addition, they feature
79
See D’Arcy Power’s translation in De arte phisicali et de cirurgia of Master John
Arderne (London: John Bale, Sons and Danielsson, 1922). For an overview, see Jones,
‘Staying with the Programme’, pp.209-10.
97
distinctive foetal presentations and a highly original sagittal-plane view of the
anatomical body. The images have the whimsical features characteristic of illustrations
of Arderne’s works, but here these qualities are accentuated: the many sick or diseased
figures are pictured wearing a wide variety of fashionable garments and assume diverse
facial expressions and bodily postures. There is a distinct quotidian aspect to the
illustrations with the inclusion of such commonplace aristocratic items as canopied
beds, mirrors, books, rosary beads, latrines, rings, dog leashes and baskets. The
Anatomical Man is depicted as holding back his own skin in order to reveal his
abdominal and thoracic organs, and a posterior view of the same man revealing the
organs on that side of the body is revealed on the verso side of the membrane.
The unwieldy nature of the roll, and its incomplete sections of text, makes it seem
unlikely that it would have been used as a reference guide by a surgeon and this, along
with its sophisticated and vibrant drawings, suggests an ornamental function. Moreover,
the exceptional finances that would have been behind its lavish and intricate design (as
well as the choice of producing it on vellum) suggest an aristocratic owner(s).80 The
lack of any information regarding its provenance (it was discovered in Sweden in the
eighteenth century) has led D’Arcy Power to postulate that it may have arrived in
Sweden with Phillippa, daughter of Henry IV (1367-1413), who, in 1406, married Eric
of Pomerania (c.1381-1459), king of Norway and Sweden.81 Another possibility could
be that it was owned by the Bridgettines of Syon Monastery at Isleworth (Middlesex),
80
For discussion of the roll’s material features, see Scott, Later Gothic Manuscripts,
Vol. II, p.199. Scott also dates the creation of the Roll to 1425-35.
81
Power, ‘Introduction’, in De Arte Phisicali, pp.xi-xii.
98
connected to Sweden by their order.82 Importantly, the eclectic mix of social and
domestic scenes with anatomical and surgical images suggests a recreational as much as
a pedagogical reception.
One of the most prominent features of the Stockholm Roll is the opposition in the
marginal images between opulent clothing and exposed bodies and members,
particularly genitalia. Whilst the revelation of body parts carries the ostensible function
of displaying the injured or diseased condition exemplified in the text, the navigation
between extravagance and abjectness in these images suggests the presence of other
themes. The depictions of lavish clothing also chime with a marked focus throughout
the text on cosmetic remedies: it includes recipes to mitigate ageing, to add hair
colouring and to overcome hoarseness. The recipe for hair colouring, for instance, is
accompanied by the image of a woman rubbing her hair in front of a mirror (fig.2).
Such aspects, then, problematise the exclusively functional view of Arderne’s works,
and the relationship between text and image therein. Although the striking, playful
images in the roll, as with other Arderne manuscripts, may provide an indexical
82
Syon Monastery was commissioned by Henry V (1386-1422) as part of an attempt to
engender religious reform in England. There was a strong connection between Syon and
its sister house at Vadstena in Sweden, particularly during the years following its
establishment, which included mutual visitations and some textual exchange. See Elin
Andersson, ‘Questions and Answers on the Birgittine Rule: A Letter from Vadstena to
Syon Abbey 1421’, The Journal of Medieval Monastic Studies, 2 (2013), 151-72, and
‘Birgittines in Contact: Early Correspondence between England and Vadstena’, Eranos,
102 (2004), 1-29. The Syon additions to the Bridgettine rule are discussed in chapter
three of this thesis.
99
function thus aiding the reader’s retention of the associated medical condition, this does
not preclude their potency to trigger various responses and emotions for the texts’ late
medieval readers.
Yet the dearth of analyses exploring such features in Arderne’s writings (and
indeed in the wider medical literature of the later Middle Ages) appears to result from
the strength of the functionality argument to foreclose alternative readings. This is
especially so because of the most prominent (and most copied) images of Arderne’s
writings, that of the naked lower-body, illustratively marked with fistula holes.
Although there has been a recent turn towards appraising images of the unclothed body
in medieval art, this has largely omitted depictions of nakedness in medical texts.83 In
one sense, this may be to do with the necessity of representing the body in medical
works for functional purposes; images (or descriptions) that would have been usually
considered obscene by medieval readers were thus accepted or tolerated in the case of
medical texts.84 Consequently, today, there appears to be an implicit acceptance that
whilst medieval representations of the naked body could carry multiple associations in
83
See the collection of essays in The Meanings of Nudity in Medieval Art, ed. by Sherry
C.M. Lindquist (Farnham, Surrey and Burlington, VT, 2012), and those in Medieval
Obscenities, ed. by Nicola McDonald (Woodbridge and Rochester, NY, 2006).
84
Alastair Minnis notes, for instance, how the French Romance writer, Christine de
Pisan (1364-c.1430), railed against obscene language in romance literature but conceded
that certain words might be permissible in a ‘diagnostic context’. See Minnis, ‘From
Coilles to Bel Chose: Discourses of Obscenity in Jean de Meun and Chaucer’, in
Medieval Obscenities, ed. by Nicola McDonald (Woodbridge and Rochester, NY: York
Medieval Press, 2006), pp.156-78 (pp.173-4).
100
religious art, for instance, its presence in medical works is restricted to conveying
necessary information to the practitioner-reader.85
But the Stockholm Roll shows how such ‘medical’ images are firmly embedded in
the wider cultural traditions and discussions about the status of the body and its
representations. This can be seen in the way its images evoke contemporary marginal
motifs in manuscripts. Michael Camille’s work on marginalia has shown how the
monstrous or hybrid bodies depicted in late medieval religious manuscripts, constituted
‘a realm of otherness at the edges of things’.86 Noting how a modern sensibility might
find the presence of naked body parts, sexual references and scatological elements
(often fulfilling a satirical role) in such manuscripts inexplicable, Camille shows how
they are embedded in schemes that affirm the stable, orthodox text at the centre of the
page ‘counterposed with something even less stable, more base, and in semiotic terms,
even more illusory – the image on the edge’.87 Whilst the images in the Stockholm Roll
are constituted differently, being indexed closely to the text as exemplifiers, they
encompass features of such marginalia in the variety of facial expressions and bodily
85
On the different significations of nudity in medieval art, see Lindquist, ‘Meanings of
Nudity’, pp.1-46 (p.2).
86
Michael Camille, Images on the Edge: The Margins of Medieval Art (London:
Reaktion, 1992), p.75.
87
Camille, Images on the Edge, p.26.
101
gestures, as well as the spectacle of aristocrats and religious figures enduring diseases
affecting their genitalia and their assumption of compromising positions.88
Whereas most figures in the roll’s margins are depicted folding back their clothing
to reveal their diseased or wounded body parts, there are only a few fully nude marginal
figures. These images tend to display the more abject conditions such as anal flux, or
the more severe genital diseases. The moral dimensions of such conditions are indicated
in one image on the first membrane of the roll: it accompanies a recipe against pruritus,
or excessive itching, and depicts an unclothed woman suffering from the condition
(fig.3). She appears to be scratching both her posterior (which is covered in sores) and
her genitalia (although she could alternatively be applying the ointment which the text
advocates). The image is redolent of moral and didactic references to sexually dissident
and lustful behaviour. Her long yellow, loose hair and nakedness accords with
conventional images of Eve, or cognate personifications of Lust or Vanity, in the
Middle Ages; the placing of her hand over her genitalia further evokes the conventional
representation of Eve drawing attention to her sexuality by placing her hand on the figleaf covering it. It also resonates with a theological linking between itching and sexual
desire or pleasure.89 Her close resemblance to the woman with the mirror at the top
88
Although, as Camille notes, such motifs were on the wane by the fifteenth century,
making way for a greater ‘naturalism’; the Stockholm Roll images can be seen as both
representative and possessing satirical features.
89
See Diane Wolfthal, Images of Rape: The “Heroic” Tradition and its Alternatives
(Cambridge and New York: Cambridge University Press, 1999), pp.43-45; Lindquist,
‘Meanings of Nudity’, p.6; Martha Easton, ‘Uncovering the Meanings of Nudity in the
Belles Heures of Jean, Duke of Berry’, in Meanings of Nudity, ed. by Sherry C.M.
102
right hand of the membrane (fig.2) further suggests vanity, as does her relative ‘fallen’
position, situated at the bottom left corner of the membrane. Such anti-feminist
associations are overlaid with other evocations of marginalisation, particularly in the
way that her visible skin-condition evokes leprosy and Levitican banishment. This
image, then, does not merely index pruritus: it is freighted with a host of sexual and
moral resonances and can be seen to offer a kind of visual exemplum for the reader,
warning against worldly vanity and sexual lust, as well as representing both the medical
and moral consequences of such behaviour.
Although remaining distinct, by virtue of its anti-feminine qualities, the image of
this woman does align with the other images in the roll representing (mostly male)
bodies in contorted, restricted or generally compromised positions. They appear to
signal that, despite the obvious wealth and high status of many of the figures, they are
nonetheless susceptible to illness and disease. The rendering of particular diseases in
Lindquist, pp.149-81 (p.149). In his Confessions, Augustine says: ‘At last my mind was
free from the gnawing anxieties of ambition and gain, from wallowing in filth and
scratching the itching sore of lust [et volutandi atque scalpendi scabiem libidinum]’; see
Confessions, trans and ed. by R.S. Pine-Coffin (London and New York: Penguin, 1961),
1:9 (p.181). On Hugh of St. Victor equating lust with itching, see Ian P. Wei,
Intellectual Culture in Medieval Paris: Theologians and the University,c.1100-1330
(Cambridge and New York: Cambridge University Press, 2012), p.269. On moralists’
linking itching with masturbation, see Dyan Elliot, ‘Pollution, Illusion and Masculine
Disarray’, in Constructing Medieval Sexuality, ed. by Karma Lochrie, Peggy
McCracken and James Alfred Schultz (Minneapolis: University of Minnesota Press,
1997), pp.1-23 (p.9).
103
labile terms is evinced by the inclusion of two falling figures (fig.4), sufferers of
epilepsy and cramp, who are respectively indexed to two charms, included in the text,
meant to ward off both conditions.
However, the traditional relationship between marginal image and text is ruptured,
in the roll, by the presence of the series of full-bodied figures at its centre. The images,
that of a Blood Vessel Man, a skeleton, a Nerve Man and an Anatomical, Man,
interspersed with images of the anal fistula operation, and followed by the foetal
presentations, run through the middle of the first four membranes. Whilst, as mentioned,
these images are most typical of the kind of depictions found more generally in
medieval medical texts, they still participate in the wider themes present in the marginal
images.90 Thus, the themes of vanity and labiality are intensified by the laughing
skeleton, which looks across the text at the marginal figure of a frenzied man pointing
up at it, and appears to cast derision on the descriptions and images of medical cures
and social hierarchy surrounding it (fig.5). The confrontation is not dissimilar to
memento mori images where living nobles or kings are reminded of their mortality by
skeletons or decaying bodies; it contextualises the ailing bodies and vain postures of the
marginal figures in terms of both their mortal and anatomical parity.91
90
The iconographic tradition of representing the foetus during pregnancy dates back to
Antiquity. See David Gourevitch, ‘John Arderne: De Arte Phisicali et de chirurgia’, in
Early Medicine from the Body to the Stars, ed. by Gerald d’Andiran and Vincent Barras
(Basel: Schwabe, 2010), p.94.
91
A common example of this is one found in images and narratives featuring three
kings who encounter three skeletons (sometimes whilst out hunting), see Christine M.
104
It is the startling, profusive figure of the Anatomical Man in the second membrane
that most completely undermines the traditional dialectic between stable text and
aberrant marginalia (fig.6). Bursting through the middle of the roll and holding apart the
skin and flesh of his torso with his hands, he draws attention to the material roll itself, as
if the moment of revelation of his abdominal and thoracic organs coincided with the
tearing of the vellum to reveal its innards. This reference to the roll’s materiality is
extended by the presence of the back of this torn body on the dorsal surface of the
membrane (fig.7). Indeed, his drawing attention to his own ruptured body is not
dissimilar to the contemporary devotional motif of ‘man of sorrows’ images.92 The full,
‘naturalistic’ exposition of the internal organs afforded by this double perspective is
accompanied by the invitation to the reader, encoded in the image of the bifurcated
codex-like body, to peruse its internal densities and folds. The revelation of wounded
skin, achieved through the lifting, or gathering, of clothing in the marginal images, is
Boeckl, Images of Plague and Pestilence: Iconography and Iconology (Kirksville MO:
Truman State University Press, 2000), pp.69-90.
92
On images of the ‘man of sorrows’ see Bernhard Ridderbos, ‘The Man of Sorrows:
Pictorial Images and Metaphorical Statements’, in The Broken Body: Passion Devotion
in Late-Medieval Culture, ed. by A.A. MacDonald, H.N.B. Ridderbos and R.M.
Schlusemann (Groningen: Egbert Forsten, 1998), pp.143-81, and David S. Areford,
‘The Passion Measured: A Late-Medieval Diagram of the Body’, The Broken Body, ed.
by Mac Donald et al., pp.211-38. See also Martha Easton, ‘The Wound of Christ, the
Mouth of Hell: Appropriations and Inversions of Female Anatomy in the later Middle
Ages’, in Tributes to Jonathan J.G. Alexander: The Making and Meaning of Illuminated
Medieval and Renaissance Manuscripts Art and Architecture, ed. by Susan l’Engle and
Gerald B. Guest (London: Harvey Miller, 2006), pp.395-414.
105
paralleled and heightened here by the uncovering of the body’s cavities. This resonates
with Karl Steel’s idea of descriptions of the flayed body in late medieval literature
evoking a kind of ‘absolute nudity’, and signalling what he sees as an ‘unendurable
intensification of the ineluctable vulnerability that constitutes any existence’.93 This
figure, then, although in one sense bespeaking legibility and comprehensibility, appears
to cast doubt on the project of overcoming bodily illness and deficiency, embedded in
the wider text; similarly, it obstructs the linear and ordered reading enterprise by forcing
the written text to curve about its contours. In doing so, it negates both curative
strategies and worldly hierarchies and vanity. It affirms, instead, the excessive flesh and
viscous materiality (as evinced in the bleeding and sore marginal bodies surrounding it),
which constantly threatens to overcome the vulnerable body. This image of the tender,
defenceless body is replicated in the foetal presentations below the Anatomical Man.
The series of depictions of fully developed foetuses encased in jar-shaped uteri,
accompanied by text advising midwives on dealing with abnormal birth positions,
further underlines the tension between a curative knowledge and the inherent
vulnerability of the body.
The Stockholm Roll is not simply an illustrative and practical guide to medical
practice; it is a densely textured document that constitutes an overlaying of the
medicalised body with moral and theological registers. The unusual format of the roll
indicates how it would have been encountered: it is likely that it would have been hung
on display where its larger images (and the responses they elicited) would have been
most prominent. The organisation of the text also reflects the interest of the roll’s owner
93
Karl Steel, ‘Touching Back’, in Reading Skin, ed. by Katie L. Walter, pp.183-96
(p.189).
106
and/or commissioners: the curtailment of Arderne’s introduction, giving way to the
catalogue of recipes and case histories, bespeaks an interest in retaining a narrative
framework whilst circumventing its precise details. The retention of Arderne’s set of
distinctive anal fistula images, replete with large surgical instruments impaling
sufferers’ bodies, whilst effacing the description of the operation they refer to, reveals
how they shed their indexical status becoming instead signifiers of the wounded or
fragmented body. Their appearance, strewn around the central images of the skeleton
and Anatomical Man, further indicates such an appropriation. In this sense, the
significance of the Stockholm Roll not only resides in its distinctive format, its lavish
images and expensive vellum, indicating as it does an aristocratic provenance; it also
shows how Arderne’s corpus of works, his text and images, could be extrapolated and
reassembled to serve differing contexts and audiences. The choices by the producer or
commissioner of which material to include in the roll ultimately indicates the kind of
preferential and selective reading practices undertaken by Arderne’s fifteenth-century
readers, and the way his works could prove amenable to their recreational and didactic,
as well as informational, needs or purposes.
107
Fig.2: Woman with mirror. Detail
Stockholm Roll. 1400-1450.
Kungliga Biblioteket MS X.118,
Membrane 1.94
Fig.3: Woman with pruritus. Detail.
Stockholm Roll. 1400-1450.
Kungliga Bibliotek MS X.118,
Membrane 1.
Fig.4: Writhing or falling figure alongside text of a prayer against cramp. Detail.
Stockholm Roll. 1400-1450. Stockholm, Kungliga Biblioteket MS X.118, Membrane 2.
94
All images from Stockholm, Kungliga Biblioteket MS X.118 are reproduced with
permission from the librarian, National Library of Sweden.
108
Fig.5: Skeleton. Detail. Stockholm Roll. 1400-1450.Stockholm, Kungliga Biblioteket MS
X.118, Membrane 1.
109
Fig.6: Anatomical Man, front view. Detail. Stockholm Roll. 1400-1450. Stockholm,
Kungliga Biblioteket MS X.118, Membrane 2.
110
Fig.7: Anatomical Man, rear view. Detail. Stockholm Roll. 1400-1450. Stockholm,
Kungliga Biblioteket MS X.118, Membrane 2v.
111
Moral and Figurative Medicine
The religious and moral features in the Stockholm Roll are paralleled by similar textual
references in Arderne’s works. His employment of figurative language, particularly in
the deontological section of the Practica, participates in a penitential, didactic tradition
of using medical metaphors to exemplify theological and moral concepts. Arderne
encourages the surgeon to cultivate a courteous and reassuring manner;95 one way of
displaying this is through his memorising of a stock of bon mots and phrases which can
be deployed when the patient is uneasy at the prospect of the surgical procedure he is
facing:96
Lere also a ȝong leche gode prouerbeȝ pertenyng to his crafte in counfortyng of
pacienteȝ. Or ȝif pacientes pleyne that ther medicynes bene bitter or sharp or sich
other, than shal the leche sey to the pacient thus; ‘It is redde in the last lesson of
matyns of the natiuitè of oure lord that oure lorde Ihesus criste come into this
world for the helthe of mannes kynd to the maner of a gode leche and wise’.97
The practical value of such instruction, in placating an apprehensive patient confronting
uncomfortable or painful (as well as potentially dangerous) treatment, is clear: the
95
On the relationship between confessional discourse and the late medieval
development of fiduciary standards among medical practitioners, see Peter Biller,
‘Introduction’, in Handling Sin: Confession in the Middle Ages, ed. by Peter Biller and
Alastair Minnis (Woodbridge and Rochester, NY: York Medieval Press, 1998), pp.1-33.
96
In the deontological section, Arderne’s hypothetical patient is resolutely male,
although he does mention some female patients in his case histories. I address the
masculine co-ordinates of the patient-figure in the next chapter.
97
Arderne, Treatises, p.7.
112
patient’s degree of co-operation would, in itself, have implications for the outcome.98
Nonetheless, the link Arderne makes, in this passage, between the patient’s fortitude
and spiritual wellbeing evokes the longstanding correspondence, as well as tension,
between medicine and Christianity. This is embedded in the reference to the Christus
Medicus, or Christ-as-physician, which underscores the blended nature of physical and
spiritual health.99 Arderne’s prescription of this rather formal utterance on the part of the
surgeon – ‘It is redde in the last lesson of matyns’ – suggests an idea of the surgeon not
just as physical healer but as a spiritual healer.
Therefore, Arderne incorporates distinct modes of spiritual discourse in his
advice. In one sense, his use of scriptural quotations to expound a more general moral
lesson is indicative of the sermon.100 The formal register adopted by Arderne’s
98
Whilst deontological sections of scholastic surgical treatises do emphasise the
importance of the surgeon’s reassuring language, it is unusual for them to recommend
that he cite from specific passages from Scripture. Likewise, the idea of a spiritually
edifying suffering is absent from most scholastic treatises. Again, Arderne’s
incorporation of such features in his appropriation of scholastic deontology is indicative
of the heterogeneous make-up of his writings.
99
Arbesmann, ‘The Concept of “Christus Medicus”’, pp.1-28.
100
The use of specific quotations, a characteristic of the sermo, was in distinction to the
more traditional homilia, which proceeded exegetically through an extensive scriptural
passage explaining it line by line. See H.L. Spencer, English Preaching in the Late
Middle Ages (Oxford and New York: Oxford University Press, 1993), pp.228-47. See
also Sabina Volk-Birke, Chaucer and Medieval Preaching: Rhetoric for Listeners in
113
hypothetical surgeon shows how sermons could ‘betray their influence, […] in the use
of forms of address appropriate to a congregation’ in writings other than sermon
literature.101 Furthermore, the intimate surgical context, featuring the practitioner giving
moral encouragement to his patient, resonates with the confessional context. This can
also be seen where Arderne proposes to his surgeon-reader to cite a passage from
Matthew’s gospel, where Christ demands of his disciples to suffer as he has:
‘May ȝe drink þe chalice þat I am to drink?’ […]; as ȝif he seid to þam, ‘ȝif ȝoure
soule or mynd couaite þat deliteþ, drinke þe first þat soroweþ or akeþ’. And so by
bitter drinkis of confeccion it is come to the ioyes of helþe. […] It semeþ a gret
herted man for to suffre sharp þingis; he, forsoþ, þat is wayke of hert is noȝt in
way of curacion, ffor why; for soþe in al my lyf I haue sene but fewe laborante in
þis vice heled in any sikenes.102
Arderne’s advocacy of the wholehearted acceptance of pain (or, more specifically, of
the discomforts of bitter purgatives) as conducive to spiritual health thus incorporates
penitential discourse to emphasise that the sufferings induced by surgery are beneficial
for the health of the patient’s soul, as well as his body. By grounding his advice to
worried patients in scriptural exegesis, Arderne invests the surgeon’s speech with the
weight of religious tradition and authority. This entails a persistent movement between
metaphorical and literal pain: the reference to the bitter drinks of confession works, on
one level, metaphorically but, on another, they refer to the actual sour purgatives the
surgeon may require the patient to drink. It underlines how the literal act of drinking
purgatives, or enduring their effects, can be spiritually rewarding. Likewise, the ‘ioyes
Sermons and Poetry (Tübingen: G. Narr, 1991), and Carolyn Muessig, ed., Preacher,
Sermon and Audience in the Middle Ages (Brill: Ledien, 2002).
101
Spencer, English Preaching, p.111.
102
Arderne, Treatises, pp.7-8.
114
of helþe’ could equally refer to bodily or spiritual health. The ‘gret herted’ patient who
can ‘suffer sharp þingis’ is following Christ’s acceptance of his cross, and this analogy
works to cast the surgical procedure as much as a spiritual exercise, entailing the
difficult act of purging one’s sins, as a physical treatment comprising the purging of
corrupt bodily humours. The work of the surgeon, in his words and deeds, is to bring the
patient, with the correct disposition and attitude, closer to Christ as well as to return him
to physical health.
The use of such language, in delineating the relationship between practitioner and
patient, aligns the surgical encounter with the confessional one, and in doing so, helps to
bolster the professional authority and legitimacy of the practitioner. However, this is not
to be seen in terms of a grafting of confessional onto medical language, as if
confessional discourse has its own separate domain distinct from the medical one.
Arderne’s use of medical metaphors to elucidate religious truths participates itself in the
widespread practice within penitential literature of the use of this kind of figurative
language. In such literature, the deployment of medical or surgical metaphors had a
clear function: to quote Jeremy J. Citrome: ‘Surgery, because it both healed and hurt,
could uniquely signify the profound ambivalence, the tension between merciful and
punitive registers, that constituted humanity’s relationship with the divine in the English
Middle Ages’.103 Writers of penitential texts could thus illustrate the necessity of pain,
both in this life and the next, as expediting salvation. In particular, the figure of the
surgeon, inducing pain for the benefit of the patient’s physical health, provided a means
of characterising the rewards to the soul of entering into the sacrament of penance,
through the mentally painful and uncomfortable act of uttering one’s sins to a confessor
103
Jeremy J. Citrome, Surgeon in Medieval English Literature, p. 2.
115
and receiving correction from him. However, as Citrome shows, the neat metaphor of
the physical wound representing spiritual sins is blurred by the understanding within
humoral theory that excessive or immoderate behaviour could itself induce many of the
diseases that a surgeon might encounter. Ailments, in this sense, become ‘the physical
inscription of sin upon the body, an earthly reminder of the fragmenting punishments
that await the bodies of the damned […] in the afterlife’, requiring the surgeon to take
the role, like the priest, of a ‘disciplinary agent of God’.104
Indeed, the abiding presence of medical tropes in confessional literature may be
sourced to its presence in the Omnis utriusque sexus decree of the Fourth Lateran
Council, which required that all who belonged to the Church (and had reached an
appropriate age) should confess at least annually:
Let the priest be discreet and cautious, that he may pour wine and oil into the
wounds of the one injured after the manner of a skilful physician [more periti
medici superinfundat vinum et oleum vulneribus sauciati], carefully inquiring into
the circumstances of the sinner and the sin, from the nature of which he may
understand what kind of advice to give and what remedy [remedium] to apply,
making use of diverse treatments to heal the sick person [diversis experimentis
utendo ad sanandum aegrotum].105
The presence of the medical metaphor, in this passage, emphasises how, at the point of
its formal institution, confessional discourse was inscribed with a register indebted to
medical knowledge and practice. Although, as mentioned in this thesis’s introduction,
one object of Lateran IV was to privilege the power of the Church over that of
physicians, the amenability of medicine to elucidate theology prevailed. Central to this
alignment was the rhetorical symmetry between the opening of the material body by the
104
Citrome, Surgeon in Medieval English Literature, p.11-12.
105
DDGC, p. 570. Translation based on Schroeder’s in DDGC, p.260.
116
surgeon (to expel excessive and corrupt humours) and the confessor’s eliciting of the
subject’s internal transgressions.106 For the Lateran IV authors, and those of the ensuing
penitential manuals, medical imagery could render comprehensible, the idea of the
unseen, abstract space of the individual soul, infected by sin. Arderne’s inversion is to
re-appropriate the metaphor back into the medical context, as a way to stress the
surgeon’s purchase on the patient’s spiritual health. At the point when other late
medieval English religious and literary authors were incorporating medical language in
their writings, Arderne can be seen to participate in this process. In this sense, he should
not be seen as a ‘secular’ writer appropriating sacred discourse; rather, the generic
concept of a discrete late medieval ‘secular’ mode of writing, in opposition to a sacred
one, is undermined by the intertwining of medical and religious registers outlined
here.107
106
On the role of confessional discourse in engendering subjectivity, see Michel
Foucault, The History of Sexuality:The Will to Knowledge, trans. by Robert Hurley, Vol
I (London: Penguin, 1998), and Karma Lochrie, Covert Operations: The Medieval Uses
of Secrecy (Philadelphia: University of Pennsylvania Press, 1999), pp.13-25. See also
Rabia Gregory, ‘Penitence, Confession, and the Power of Submission in Late Medieval
Women's Religious Communities’, Religions, 3 (2012), 646-61.
107
Indeed, a recent volume on secular critique shows that the problematising of the
opposition between the sacred and the secular need not be confined to the Middle Ages.
See Talal Asad, Wendy Brown, Judith Butler and Saba Mahmood, Is Critique Secular?
Blasphemy, Injury and Free Speech (Berkeley, Los Angeles and London: University of
California Press, 2009).
117
Fig.8: Owl. John Arderne’s Liber medicinalium. 1400-1425. London, BL Sloane MS 56,
f.54v.
Owls, Sin and Anal Bleeding
The perspective on Arderne and his writings, which I propose here, departs from the
conventional view of his enclosure within the tradition of rational medicine. Employing
a medical humanities methodology allows us to situate him within late medieval
English vernacular culture, characterised by the circulation and overlapping of literary,
religious and technical literature. Arderne is not an author whose distinctive qualities
and idiosyncrasies are quirks impinging on an otherwise orthodox scholasticism; his
variegated works absorb many of the moral and rhetorical features constitutive of his
immediate culture. I have analysed an instance of this in relation to images of pruritus in
the Stockholm Roll. The conditions most strongly associated with Arderne, those
affecting the anus, are especially significant for the moral associations they evoke; such
resonances are evident in his representations of these conditions.
One marginal image consistently featured in Arderne’s Liber is that of a horned
owl; this is typically positioned alongside a passage where Arderne describes rectal
swelling (fig.8). The connection between the bird and the disease is made explicit in
Arderne’s description of the swelling, called bubo:
118
[B]ubo is ane aposteme bredyng wiþin þe lure in þe longaon wiþ grete hardnes but
litle akyng. Þis I sey byfore his vlceracion þat is noþing elles þan a hidde cankere,
þat may noȝt in þe bigynnyng of it be knowen by þe siȝt of þe eiȝe, for it is hid al
wiþin þe lure; And þerfore it is callid bubo, for as bubo, i.e. an owle, is a best
dwellyng in hideles so þis sikenes lurkeþ wiþin þe lure in þe bikynnyng, but after
processe of tyme it vlcerate, & fretyng þe lure goþe out.108
The term, ‘bubo’, signifying an ulcerated swelling, is also the Latin word for owl.
Arderne advances an explanation of their shared etymology by reference to their
figurative associations: they are both connected with darkness and invisibility. 109
Arderne is participating in a longstanding tradition of associating the owl with
sinfulness and horror. In his Metamorphoses, Ovid (c.43 BCE- c.17 CE) describes it in
terms of foulness and impending evil;110 throughout the medieval period, further
108
Arderne, Treatises, p.37.
109
The encyclopedist, Isidore of Seville (c.560-636), claims that the horned owl (bubo)
receives its name onomatopoeically from the nature of its call. See The Etymologies of
Isidore of Seville, trans. by Stephen A. Barney, W.J. Lewis, J.A. Beach, Oliver Berghof
(Cambridge and New York: Cambridge University Press, 2006), 12:7, l.29-46 (p.263).
The term ‘bubon’ derives from the Greek word for groin, or a swelling in the groin. It
appears that both words have separate etymologies. See ‘bubo, n.’, OED
http://www.oed.com.ezproxy.lib.bbk.ac.uk/view/Entry/24087 [accessed 7 November
2014].
110
Ovid relates the story of the mythological figure, Ascalaphus, son of Acheron, who,
on revealing that the goddess Proserpina ate a pomegranate in the underworld, is
punished by the gods by being turned into an owl and condemned to Hades. See Ovid,
Metamorphoses, trans. by Horace Gregory (New York: Mentor Books, 1960), V, 53371.
119
negative traits were imputed to the owl, ‘ranging from death and evil to stupidity and
sloth’.111 Late medieval bestiaries added a specifically Christian dimension to this
denunciation: a thirteenth-century English bestiary, held at the Bodleian library, links
the owl’s filthiness and habit of roosting in its own excrement with the sinner who
‘brings all who dwell with him into disrepute through the example of his dishonourable
behaviour’.112 The association between the owl and excrement shows how the anal
trope, which Arderne employs, was already present in the late medieval cultural
imaginary. The analogising of the owl with the sinner in this bestiary is extended to
incorporate anti-Jewish rhetoric: ‘This bird signifies the Jews, who, when our Lord
came to save them, rejected Him […], and preferred the darkness to the light’.113 As
Mariko Miyazaki shows, the abundance of negative traits constellating around the owl
in the later Middle Ages, particularly those pertaining to secrecy and excrement, made it
an exemplary model in serving articulations of cultural or racial alterity.114 By relating
the invisibility of the swellings in the rectum to the owl’s tendency to inhabit in
111
Mariko Miyazaki, ‘Misericord Owls and Medieval Anti-semitism’, in The Mark of
the Beast: The Medieval Bestiary in Art, Life and Literature, ed. by Debra Hassig (New
York and Abingdon: Garland Publishing, 2000), pp.23-49 (p.27).
112
Bestiary: Being an English Version of the Bodleian Library, Oxford MS Bodley 764,
ed. by Richard Barber (Oxford: The Folio Society, 1992) p.149.
113
Bestiary, p.148.
114
See Miyazaki, ‘Misericord Owls’, pp.23-49, and Anthony Bale, ‘Fictions of Judaism
in England before 1290’, in The Jews in Medieval Britain: Historical, Literary and
Archaeological Perspectives, ed. by Patricia Skinner (Woodbridge: Boydell Press,
2003) pp.129-44 (pp.141-2).
120
‘hideles’, or secret, places, Arderne’s writing is invested in this figurative and
condemnatory discourse, connecting the owl with maligned sinners and Jews.115
Arderne’s implicit link between an anal condition and anti-Jewish rhetoric is
calibrated by the presence of an even more direct connection in late medieval culture
between Jews and anal bleeding. Throughout the Middle Ages, Jewish men, in
particular, were associated with frequent anal haemorrhaging. Such ideas may have
originated in the biblical account of the bursting of Judas’s belly during his suicidal
hanging. In any case, they were ‘exegetically linked to Jewish deicidal bloodguilt’.116
These myths, by the thirteenth century, had crystallised into an idea, promulgated by
some, that Jews underwent a collective bleeding each Easter, usually through an anal
‘flux’, or discharge of blood, in commemoration of their killing of Christ. Bernard of
Gordon lent rational authority to the myth in his Lilium Medicinae, attributing the blood
loss to humoral excess arising from sedentary lifestyles and susceptibility to fear and
anxiety.117 David S. Katz has shown how the belief developed into the idea of a male
115
For an exposition of Arderne’s employment of the owl image in an anti-Semitic
context, see Anthony Bale, The Jew in the Medieval Book: English Antisemitisms, 13501500 (Cambridge and New York: Cambridge University Press, 2006), p.21.
116
Willis Johnson, ‘The Myth of Male Jewish Menses’, Journal of Medieval History,
24:3 (1998), 273-295 (p.273). Johnson also claims it may have been influenced by the
early Christian story of the heresiarch Arius dying from intestinal extrusion as
punishment for his heretical teachings regarding the body of Christ (p.275).
117
See Irven M. Resnick, ‘Albert the Great on the Talmud and the Jews’, in
Philosemitism, Antisemitism and ‘the Jews’: Perspectives from the Middle Ages to the
Twentieth Century, ed. by Tony Kushner and Nadia Valman (Aldershot and Burlington,
VT: Ashgate, 2004), pp.132-54, and Marks of Distinction: Christian Perceptions of
121
menses;118 this was ‘added to the list of Jewish physical peculiarities’ that were
employed by writers, preachers, commentators and illustrators to naturalise claims of
Jewish otherness.119
Late medieval narratives linking excessive anal bleeding with moral or racial
alterity abound. Many re-envision the spilling of Judas’s intestines during his hanging
as an anal flux. In the account of his suicide in the thirteenth-century hagiographical
collection, The South English Legendary, there is a particular focus on the symbolic
aspects of this incident:
His wombe tobarst amydde atwo þo he scholde deyȝe
Hys gottes volle to grounde þat monymon hyt yseyȝe
Þer wende out þe luþer gost ate mouþe he ne myȝte
Vor he custe er oure Louerd þer wyþ myd vnryȝte
Nou suete Louerd þat þoru Iudas isold were to þe treo
Jews in the High Middle Ages (Washington D.C., CUA Press, 2012); Sander L. Gilman,
Jewish Self-Hatred: Anti-Semitism and the Hidden Language of the Jews (Baltimore:
John Hopkins Press,1986) pp.74-5; Luke E. Demaitre, Doctor Bernard de Gordon, p.9.
The discussion on Jewish bleeding occurs in Bernard’s Lilium Medicinae (Lyon: G.
Rouillium, 1550), 5.21, f.77.
118
David S. Katz, ‘Shylock’s Gender: Jewish Male Menstruation in Early Modern
England’, The Review of English Studies, 50:200 (1999), 440-462 (p.449). Bernard of
Gordon’s explanation of Jewish bleeding in terms of a need to shed excessive humours
echoes standard late medieval medical explanations of female menstruation. See Katz,
pp.442-7.
119
Katz, ‘Shylock’s Gender’, p.454.
122
Schulde ous fram þe luþere stude þat we weneþ he inne beo (141-6).120
The physical spilling of Judas’s guts also constitutes the expulsion of his evil spirit or
‘luþer gost’. The statement that this cannot emerge through Judas’s mouth, because he
has kissed Christ, invokes an antithesis suggesting that ‘wombe’ here refers to the
rectum (as it was sometimes employed).121 The twelfth-century compilation of
exegetical Biblical commentary, the Glossa Ordinaria, in its commentary on the
account of Judas’s death in the canonical Acts of the Apostles, insists on the anal exit,
particularly because of its symbolic contrast with the mouth:
The bowels […] which were the seat of deceit, were burst by so great a crime that
they were unable to contain themselves. Fittingly, then, through the seat of fraud
the bowels were poured out, not through the place of the kiss - the mouth with
which Jesus was kissed, though with foul intent - but through another place, by
which the poison of hidden malice had entered.122
In both accounts, Judas’s fraudulent kiss of Christ has unintentionally privileged his
mouth as a sacred site because of its tactile encounter with Christ, implying that the
mouth would otherwise be the preferred site of expulsion. The anus works here as a
kind of anti-mouth, its foulness befitting the expulsion of the fraudulent spirit. The anal
flux acts in a similar way to visualise heretical punishment: in the vita of St. Hilary, in
120
‘Judas’, SEL, Vol. II, pp.692-7. Line numbers are cited in the text. This account is
found in Cambridge Corpus Christi College MS 145.
121
‘womb(e), n.’ (6a). http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED53355 [Aceesed 7 November 2014]. For an example of the use of
womb to refer to the rectum, see Arderne, Treatises, p.77.
122
Biblia Sacra cum GIossa Ordinaria et Expositionibus (Lyon: Gaspar Trechsel, 1545)
Vol. VI, 165v. Quoted in Johnson, ‘Myth of Male Jewish Menses’, p.279.
123
Jacobus de Voragine’s (c.1230-c.1298) hagiographical collection, the Legenda Aurea,
Hilary is described attending a papal counsel where he challenges the heretical views of
Pope Leo.123 After Hilary confronts Leo, the pope promises to punish him, but
provisionally leaves the room to relieve himself. The Gilte Legende, a mid-fifteenthcentury Middle English translation of the Legenda Aurea, describes the scene: ‘And as
the pope went to ese hymselff he pershed by a sodein flixe in puttyng oute alle his
bowelles and so he ended his lyff cursedly’.124 The disorder of heresy is both manifested
and punished by the sudden and fatal discharge of the Pope’s bowels.
The evocation of anal discharge in edifying accounts of the punishment of sin or
the identification of foreignness is thus a distinct feature of late medieval religious and
moral discourse. Arderne’s employment of the images and description of the owl
implicitly calls up such resonances in relation to rectal swelling, and his late medieval
readership would have recognised such a range of associations. He goes on to discuss its
effects, describing how it eventually proves fatal as a result of the patient’s continuous
defecation: at this point, ‘it may neuer be cured wiþ mannes cure but if it plese god, þat
made man of noȝt, for to help wiþ his vnspekeable vertu’.125 For Arderne, the anal flux
is ultimately a question of divine providence and the operations of its mysterious
‘vertu’. Whilst this condition features in a text outlining the causes, diagnosis and cures
of illnesses and diseases, its moral and cultural investments are threaded through its
123
Although this vita refers to Hilary of Poitier (c.300-c.368), Pope Leo I (c.400-461)
was born a century after Hilary. The heresy quarrel might refer to Hilary of Arles’s
(c.403-449) power struggles with Leo I suggesting that Hilary of Poitiers vita conflates
the lives of the two men.
124
Jacobus de Voragine, ‘St. Hilary’, GL, Vol. I, p.92.
125
Arderne, Treatises, p.37.
124
representation. Although the overlap between medieval medicine and religion is often
acknowledged by historians, there remains a need to situate medical texts in relation to
their wider cultural contexts. The readings of Arderne’s writings, advanced in this
chapter, focusing on their construction of an authorial persona, their mobilisation of
pietistic utterances and their moral investments, comprise such an endeavour. The
adoption of a medical humanities perspective encourages an approach that avoids
bracketing medicine as a discrete enterprise, tracing instead the discursive and rhetorical
intersections between various fields of knowledge.
125
CHAPTER TWO
Performing Illness: The Figure of the Patient
An ordinance issued by the short-lived conjoint Guild of Surgeons and Physicians, set
up in 1423 to help both professional bodies gain a monopoly on medical treatment in
London, stipulates that its members may ‘ne do no þing be way of Medicyne to no
paciente by þe whiche it is like to hym, or doubte, þat þe paciente myght stande in
perelle’.1 Surgeons, in particular, are commanded to ensure that any invasive procedure
is sanctioned beforehand by two masters of surgery ‘for saluacion of þe paciente and
worship of þe Crafte of Cirurgy’.2 The document outlines ‘þe paciente’ as vulnerable
and at the mercy of illicit practitioners. In regulating the activity of medical
professionals, the guild affirms its protective and authoritative role through its concerns
for the health of the patient. The privileging of the patient’s welfare reflects this figure’s
importance to the guild’s efforts to establish professional legitimacy and overcome
charges of ineptitude, particularly against surgeons.3 These concerns thus lead to a
1
‘The Ordenaunce and Articles of Phisicions withinne þe Cite of London and Surgeons
of þe same Cite’, in A Book of London English 1384-1425, ed. by R.W. Chambers and
Marjorie Daunt (Oxford: Clarendon Press, 1931) pp.108-15 (p.111).
2
‘Ordenaunce and Articles’, p.111.
3
For reference to popular material condemning medical practice and practitioners, see
Linda Ehrsam Voigts, ‘Herbs and Herbal Healing Satirized in Middle English Texts’, in
Herbs and Healers from the Ancient Mediterranean through the Medieval West: Essays
in Honour of John M. Riddle, ed. by Ann Van Arsdall and Timothy Graham (Farnham
and Burlington, VT: Ashgate, 2012), pp.107-52.
126
configuration of the patient in terms of two characteristics: he is in ‘perelle’; yet,
through licensed treatment, he may receive ‘saluacion’.
The religious connotations of the language in the guild’s ordinance reflect the
spiritual dimensions inherent in the term, ‘the patient’. The word is etymologically
grounded in the Latin verb patī, to suffer, and this informs the meaning of the adjective,
patient, or patiēns, describing the qualities of calmly enduring or willing to bear
suffering, as well as those of tolerance or forbearance. The word circulated in Latin
throughout the post-classical period, usually denoting a ‘person who endures’, in line
with the promotion of patience as a virtue in classical philosophy, Scripture and earlyChristian theological works.4 This meaning persisted in the word’s Middle-English (and
Anglo-Norman) derivative ‘pacient(e)’ but was supplemented with other meanings: it
denoted one who receives correction or discipline; more generally, it described a
passive recipient of an action; and (more familiarly today) it referred to a sick person.
The earliest use of the noun recorded in the Middle English Dictionary is
Chaucer’s reference to the Physician’s encounters with his patients in the Prologue to
The Canterbury Tales.5 The usual terms employed to describe the person under the
physician’s or surgeon’s care in Latin texts prior to the fourteenth century was aegrotus
or aegrota, ‘sick man’ or ‘sick woman’. This began to be alternated in medical writings
in Latin, from the fourteenth century, with the term ‘patiente’ (for example, Guy de
4
‘patient, adj. and n.’, OED
http://www.oed.com.ezproxy.lib.bbk.ac.uk/view/Entry/138820?rskey=D8YNCL&result
=1&isAdvanced=false [accessed 29 October 2014].
5
‘pacient(e), n.’, MED http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED32142 [accessed 29 October 2014].
127
Chauliac employed it in his widely-circulated Latin surgical treatise).6 The adoption of
the term by Middle English writers was widespread in late fourteenth- and early
fifteenth-century translations of continental surgical treatises, as well as original works
in the vernacular. What the term, the patient, offered late medieval vernacular medical
writers was an understanding of the sick person, not just in terms of his injured or
diseased state, but in the context of a formal and reciprocal relationship with a physician
or surgeon: one became a patient by placing oneself under the auspices of a
practitioner.7 In line with the behaviour expected of the subject in this encounter, the
patient-category was idealised as incorporating the display of fortitude, particularly in
the face of the pains and discomforts of surgery, and submission to the authority of the
practitioner. The quintessential patient was seen as demonstrating the virtue of patience.
Whilst the history of the patient is one that has received much attention by
medical historians over the past thirty years, the figure of ‘the patient’ continues to be
invoked as a natural or universal concept with little or no critical attention paid to its
emergence, or its status as a cultural construct.8 In this chapter, I examine the rhetorical
6
Chirurgia magna Guidonis de Gauliaco (Lugduni: Tinghi, 1585), pp.164, 193, 236,
241, 288, 312, 339, 350, 385.
7
I employ the masculine pronoun to refer to the patient to reflect the way that this
figure is gendered as male; this is a key part of my argument in this chapter.
8
Roy Porter’s seminal studies of early modern patients influenced subsequent studies
that focus on the power disparities felt by ill patients in clinical encounters, as well as
the different social and cultural milieus patients and practitioners often inhabit. See
Porter, Patients and Practitioners and ‘The Patients’ View’, pp.167-74. See also L.
Stephen Jacyna and Stephen T. Casper, eds., The Neurological Patient in History
128
deployment of the patient in Middle English texts, and I chart the specific indices of the
term within that culture. I analyse incarnations of this figure in romance and religious,
as well as surgical, texts. I argue that the patient, as represented in late medieval
writings, is not particular to the medical sphere but is informed by ideological
understandings of, and responses to, suffering and illness pervasive in the wider culture.
Whilst the patient’s delineation in medical texts may have reflected the professional and
specific motivations of fourteenth- and fifteenth-century medical authors and compilers,
its textual formulation is not simply a reflection of encounters between practitioners and
medical subjects; the representation of the patient, in such accounts, generates instead
an idealised conception of the figure of the medical subject. This figure emerges
through an intertextual matrix comprising medical, religious and literary texts. My
analysis of the cultural representation of the patient informs my argument that the
patient is a rhetorically constructed category rather than a historically contingent one.
Suffering and Submission
Representations of the patient in English medical literature of the fourteenth and
fifteenth centuries constituted an etymological narrowing of the category as it became a
functionary term (as we would recognise it today), specifically describing the subject of
medical treatment. To what extent, if any, did the patient retain the spiritual or virtuous
(Rochester, NY and Woodbridge, Suffolk: University of Rochester Press, 2012); Lilian
R. Furst, Between Doctors and Patients: The Changing Balance of Power (Virginia:
University Press of Virginia, 1998); Helen Roberts, The Patient Patients: Women and
their Doctors (London and Boston: Pandora Press, 1985); Toombs, The Meaning of
Illness.
129
features of the term, patience, in Middle English surgical and other literature? More
specifically, what was amenable about the appellation that it became the preferred one
to delineate the medical subject? The strong emphasis on deontology, or the
practitioner’s ethical behaviour, in scholastic medical works evinces the importance of
the patient to the professional success of the practitioner. Indeed, it makes clear that the
practitioner’s successful execution of good behaviour and etiquette was as important to
his practice as prognosis, diagnosis and treatment. Furthermore, the importance of the
‘non-naturals’ in engendering health, including regulation of the passions and emotions,
meant that a calm and trusting patient would be understood as a healthier one.9
Medical historians have debated the issue of Church influence upon the ethical
advice in late medieval medical treatises. This debate has been particularly fuelled by
consideration of the edict by the Fourth Lateran Council of 1215, which stipulated that
physicians should call for a priest before commencing any medical treatment on a
patient.10 Darrel Amundsen, on the one hand, argues that late medieval physicians
followed this injunction faithfully and points to its insertion in a number of post-Lateran
medical treatises.11 On the other hand, Michael McVaugh refers to the edict’s frequent
reiteration in fourteenth-century religious decrees, to suggest that it was resisted by
physicians. He argues that the inclusion of the papal instruction in some treatises was
more a case of authors paying ‘lip service’ to the decree than displaying any sustained
commitment to it.12 McVaugh’s speculation is here embedded in a wider argument that
9
Siraisi, Medieval and Early Renaissance Medicine, p.101.
10
DDGC, p.263.
11
Amundsen, ‘The Medieval Catholic Tradition’, pp.65-107.
12
McVaugh, Medicine before the Plague, p.171.
130
insists on a firm distinction between the views of physicians, grounded in scholastic,
rational medicine, and those of the Church establishment: ‘Concern for their patients’
mental outlook left practitioners uncomfortable with the Church’s insistence […] that
they admonish the sick to confess their sins to a priest before they begin to treat them.
[…]. Doctors felt more concern about their patients’ physical than their spiritual
health’.13
However, the coordinates of this debate, predicated on the question of the extent
to which physicians incorporated religious edicts in their treatment, ignores more
fundamental ways in which spiritual and medical modes overlapped in medieval
culture. Whilst one can debate the level of influence of specific edicts or social
pressures on medical practitioners, the dynamic relationship between late medieval
medicine and Christianity is revealed most potently at the level of language, beyond any
putative concerns of medical practitioners or others. The cultural valences of, in this
case, the figure of the patient problematise the idea that medical texts evince any clear
distinction between what we would recognise as the ‘physical’ and the ‘spiritual’, the
medical and the religious. Today, our appreciation of the spiritual connotations of a
word like ‘patient’ may be greatly diminished; yet, the recitation of the virtue of
patience in myriad writings and sermons suggests that late medieval readers would have
implicitly recognised its religious resonances, and would have been unlikely to
distinguish comprehensively between the patient as a spiritual or a physical entity.
Indeed, the spiritual qualities indexed by the term, comprising sufferance and
fortitude, was one way to shore up the claims to authority made by practitioners in late
medieval England. One anonymous author writing in a surgical treatise instructs his
13
McVaugh, Medicine before the Plague, p.171.
131
reader that ‘þou must be as priuy as a confessour of þat þou seest or herist in þe
pacientis hous’.14 This advice maps the priest-penitent relationship onto the practitionerpatient one. Although the responsibilities of the practitioner are foregrounded, the
patient is implicitly invoked in terms of illicit activities, and a moral imperative to
submit to the surgeon’s authority. The need for the patient to be willing to undergo pain
during the surgical encounter is also couched in moral terms in the fifteenth-century
Middle English translation of Guy de Chauliac’s Chirurgia Magna. Guy contrasts the
‘vnbuxom pacient’, one who is unable to accept suffering, with the qualities of the ideal
one: 15
The condiciouns þat beeþ required in þe seke man beeþ thre: þat he be obedient to
þe leche as a seruaunt to his loorde […], þat he triste wel on the leche […],þat he
be pacient or suffrynge in hymself, for pacience ouercometh malice, as it is saide
in anoþer scripture.16
The application of the relationship between servant and lord to that of patient and
practitioner reverses the orthodox social hierarchy where the typically aristocratic, male
patient maintained superiority over the medical practitioner. The moral efficacy of this
obedience is signalled by reference to Guy’s proverb that ‘pacience ouercometh
malice’: the sufferer’s acceptance of the hardships of surgery, as well as the socially
meek role of the patient, is seen as an intrinsic part of his overcoming of sickness or
‘malice’. The mention that this is a condition of the patient’s receipt of treatment shows
an implicit coalescence between the idea of the patient-figure and the virtue of patience.
14
London, Wellcome MS 564, f.57v.
15
Guy de Chauliac, Cyrurgie, p.3.
16
Guy de Chauliac, Cyrurgie, p.13.
132
The typical construction of the hypothetical patient in such texts as male
underlines the efforts of practitioners to establish professional success and legitimacy.
Although women appear in some case histories by surgeons such as John Arderne, they
are usually far outnumbered by men.17 Thus women had ‘a place in the masculinised
world of literate medicine. But it was not an equal one’.18 Certainly, the model of the
ideal patient in late medieval medical texts is gendered as male.
The idealisation of the patient in terms of his spiritual significance is made clear
in the detailed and precise instructions given by the thirteenth-century oculist,
Benventus Grapheus [aka Benventus Grassus] of Jerusalem, in his references to the
interaction between patient and practitioner.19 A fifteenth-century Middle English
17
All of the patients in Arderne’s list of anal fistula sufferers are male.
18
Monica Green, Women’s Medicine, pp.117.
19
Although Benventus’s writings were circulated throughout Europe, there is no
biographical information available apart from his self-references in his treatise on
ophthalmology, De Probatissima Arte Oculorum. He is referred to in one edition of his
text as Benvengut de Salern, raising the possibility that he was associated with the
medical school at Salerno. See Benjamin Kedar, ‘Benvenutus Grapheus of Jerusalem:
An Oculist in the Era of the Crusades’, Korot: The Israel Journal of the History of
Medicine and Science, 11 (1995), 14-41 (p.34). However, the manuscripts which
include his writings do not include the heavy marginal glosses typical of a university
textbook. Although he does demonstrate knowledge of scholastic works, it is not
comprehensive. See L.M.Eldredge, ‘Introduction’, in The Wonderful Art of the Eye: A
Critical Edition of the Middle English Translation of his De probatissima arte
oculorum, ed. by L.M. Eldredge (East Lansing: Michigan State University Press, 1996),
133
translation (and commentary) of his treatise on ophthalmology, entitled De probatissima
arte oculorum, includes a description of how the practitioner should prepare for an
operation for the removal of a cataract with a needle.
And when he hath youen the pacyent purgacioun, on the day next foloyng abowt
ix of the clok whyle he is fastyng do hym sitte ouerthwart [a forme], rydyngwyse; and sytte you also on the stoke yn lyk wyse face to face. And do the
pacyent to holde the hole eye cloos with hys oon hande, and charge hym that he
syt stydfastly styl and styre not. And þen blysse the and begyn thy craft in the
name of Ihesu Cryste.20
The delicacy of the operation is underscored in Benventus’s precise instructions
outlining the time of day the operation should take place, and the posture of both patient
and practitioner, sitting across a bench facing each other. The practitioner’s control over
the patient is emphasized by the author’s injunction that the surgeon ‘do’ (command), or
p.5. Whilst historians have in the past assumed that he was a Jew who converted to
Christianity, this is treated with scepticism by modern historians. For discussion of this,
see Kedar, ‘Benventus Grapheus’, pp.32-4, and Eldredge, ‘Introduction’, pp.4-5.
20
Benvenutus Grassus, The Wonderful Art of the Eye: A Critical Edition of the Middle
English Translation of his De probatissima arte oculorum, ed. by L.M. Eldredge (East
Lansing: Michigan State University Press, 1996), p.54. This is an edition of a version
held at Glasgow, Hunterian Museum MS 513 (V.8.16). It is one of four manuscripts of
Middle English translations of the treatise. The others are Oxford, Bodleian Library, MS
Ashmole 1468; Glasgow, Hunterian Museum, MS 503 (V.8.6); London, BL Sloane MS
661. In Ashmole 1468, the treatise is accompanied by Guy de Chauliac’s surgical
treatise; in Hunterian MS 513, it precedes an antidotary and the writings of PseudoHippocrates; Sloane MS 661 forms part of a seventeenth-century physician’s notebook.
See Eldredge, ‘Introduction’, pp.20-30.
134
‘charge’, the patient to put himself in a position conducive to the efficacy of the
operation. This authority is made clear through the alliterative and tautological
instruction: ‘charge hym that he syt stydfastly styl and styre not’. The idea of the patient
that is drawn here is that of a submissive and passive subject, characterised through
stillness. Once the patient is sitting motionless in the desired position, the practitioner’s
authority is consolidated by his ritualistic blessing and invocation of Christ. In
preparation for the operation, the patient has been commanded to fast and has been
given purgatives to cleanse the body of excess humours. Although this pre-operative
advice was typical and informed by humoral theory, the mention, in this passage, that
the practitioner undertakes his operation in Christ’s name, invests these facets of the
operation with religious and ritualistic underpinnings.
The profession of the surgeon’s physical and spiritual authority is maintained in
the instructions of the patient’s aftercare. Benventus tells his reader that the patient must
lie with a plaster applied to his sore eye.
And do hym lye down in hys bed wyde opon ix days. After charge hym that he
ster not hys eye all that tyme. And thryys yn the day and tryys yn the nyght,
remeue the playster. And he to [to] lye yn a derke house.[…] When the ix days ar
past, make on the eye a tokyne of the crosse and let hym ryse vp and wasche wele
hys face and hys eyon wyth fayr colde water. And after that doo hys occupacion
that he hath to doon.21
The patient remains subject to the dictates of the practitioner and is, in this wise,
characterised again by stillness and recumbence as he lies in a dark house. The mention
that the sequestration should take place over nine days establishes a symbolic
correspondence with the ninth hour, the time the operation is meant to take place. The
accumulation of Benventus’s direct commands to his surgeon-reader, delivered through
21
Benventus Grassus, De probatissima arte oculorum, p.55.
135
short, punchy, heavily co-ordinated sentences, adds to the description’s ritualistic aura.
The conclusion of the patient’s quarantine is, like the ending of the operation, marked
religiously, this time with the surgeon making the sign of the cross over the eye. After
the patient has risen and washed his eye, he is ready to shed himself of his patient-status
and return to ‘doo hys occupacion that he hath to doon’. Therefore, the end of the
operation is outlined in terms of the patient’s resumption of his masculine (and possibly
powerful) identity, paralleling his shift from a horizontal and prone position to a vertical
one. The adoption of a Christian discourse, framing Benventus’s directions pertaining to
the operation and its aftercare, works to construct the practitioner as a spiritual
authority-figure and the patient as one who is undergoing a spiritual, as well as a
physical, cure.
The blending of Christian beliefs and gestures with medical practice in
Benventus’s text outlines the patient according to specific factors: he is submissive,
sequestered and his cure is engendered through a combination of the surgeon’s skill and
God’s grace. The patient is seen to embody the qualities of submission and resolution,
and he enacts them in a series of ritualistic gestures. The authorial motivation for
drawing the patient in this particular way may be rooted in the desire for professional
legitimacy or institutional necessity. Whatever the intention, the patient emerges, in this
text, through the adoption of a particular register, incorporating the blending of medical
and religious languages, and embedded in ideas and ideals of suffering germane to the
wider culture.22
22
On the possible influence of Benventus on Chaucer, see James M. Palmer, ‘Your
Malady is no “Sodeyn Hap”: Ophthalmology, Benventus Grassus, and January’s
Blindness’, The Chaucer Review, 41:2 (2006), 197-205.
136
Such figurations do not reflect the reality of the medical encounter so much as
construct it. This perspective problematises the idea of reciprocity as outlined, for
instance, by Kirk L. Smith, in his discussion of the relationship of trust between patient
and practitioner:
The physician’s specific morality had somehow to be linked to his specific
function and to those occasions when the patient was formally subject to medical
knowledge and skill. Eventually, this would lead to the profession’s submission to
the fiduciary standard, i.e., the bond of implicit trust established between the
caregiver and the recipient of care.23
In this exchange, the physician would demonstrate his superlative knowledge and
morality to gain the patient’s trust; in turn, the patient would submit his body to the
authority of the physician. McVaugh makes a similar point arguing that, at the
beginning of the relationship with a patient, the physician had to ‘convince his patients
that he knew something they did not […] and that they should concede him authority
and power over them in treatment’.24
Whilst such reciprocity may well have been a feature of healing encounters, it is
important to acknowledge the way that the practitioner-patient relationship was
textually inscribed: our knowledge of this relationship derives principally from the way
it is configured in the deontological sections of medical treatises. The patient, in late
medieval texts, is not representative of a ‘real’, fully-formed subject, approaching the
encounter with a practitioner as an equal stakeholder. Instead, the medical subject
emerges from within the medical (or other) text and this figure establishes the
23
Kirk L. Smith, ‘False Care and the Canterbury Cure: Chaucer Treats the New Galen’,
Literature and Medicine, 27:1 (2008), 61-81 (p.70).
24
McVaugh, Medicine before the Plague, pp.166-7.
137
lineaments to which the actual bodies of sufferers were meant to conform. The patient is
summoned through the cumulative writings of medical authorities and pre-inscribed
with the qualities of sufferance, fortitude and a willingness to submit to the authority of
the practitioner, as a penitent would to a confessor. In this wise, the patient retains the
spiritual capabilities, invested in the term’s etymology, but is, in its medical
configuration, divested of their heterogeneous features. Whereas those who were
typically imagined as ‘patient’ sufferers in the Christian economy were often the poor
and those who were morbidly sick, the hypothetical patient in the deontological sections
of medical treatises is, as mentioned above, powerful, aristocratic and male. The
spiritual benefits offered to this patient may thus be seen as compounded by the social
reversal that accompanies his (provisional) transformation from powerful aristocrat to
passive patient.
Lovesick Gestures
The stylised depictions of the patient, in Benventus’s treatise, assuming various postures
and receiving spiritual blessings, whilst the surgeon cuts into his eye, invoke the
fortitude and deferential mien of sufferers in other contemporary literature. The medical
patient is not an isolated figure, confined to the specifics of the medical encounter; he is,
rather, in dialogue with a variety of ailing figures in other kinds of writings. Romance
texts typically represent amatory desire through the figure of the aristocratic male,
adopting a range of codified gestures whilst pining for his beloved. Indeed, there is an
explicit connection between the medical patient and the romance hero, in that they are
both ill: lovesickness, or amor hereos, was recognised in medical scholastic texts as an
ailment, which could be treated medically. The writings of Constantinus Africanus, the
138
Benedictine monk responsible for much of the transmission of Arabic medicine into the
Western canon, greatly informed medical perspectives towards amor hereos and the
idea of the lovesick patient. One chapter of his Viaticum peregrinatis, a Latin translation
of an Arabic medical handbook, is devoted to lovesickness and includes rational
explanations for the excessive feelings and torpidity wrought by this condition.25 The
influence of Constantinus’s description of amor hereos is evinced in subsequent
references to the condition by some of the most prominent European scholastic authors,
including Gerard of Berry (fl.1180-1200), Arnaldus de Villanova (c.1240-1311),
Bernard of Gordon and John Gaddesden (d.1361).26 Such accounts described it as
arising from an accumulation of hot and dry humours and as generating a ‘sexually
stimulating heat’.27 Symptoms could pertain to the body, as well as the mind, and
25
The Viaticum was a liberal translation of a medical treatise by the Arabic physician,
Ibn al-Jazzar (c.895 – c.979). Ibn’s text, drawing on his views of lovesickness from
numerous classical and Arabic authorities including Galen and Rufus of Ephesus (fl.100
CE), categorised it as a disease of the head. See Mary Wack, Lovesickness in the Middle
Ages: The Viaticum and Its Commentaries (Philadelphia: University of Pennsylvania
Press, 1990), pp.182-5; John Livingston Lowes, ‘The Loveres Maladye of Hereos’,
Modern Philology, 11:4 (1914), 491-546 (pp.513-16 and 517-20); Carol Falvo
Heffernan, The Melancholy Muse: Chaucer, Shakespeare and Early Medicine
(Pittsburgh, PA: Duquesne University Press, 1995), pp.66-94; Michael R. McVaugh,
‘Introduction’, in Tractatus de amore hereoico. Arnaldi de Villanova: Opera medica
omnia. Vol. III (Barcelona: Edicions de la Universitat de Barcelona, 1985), pp.11-39
(pp.14-15).
26
Lowes, ‘Loveres Maladye’, pp.495-507.
27
Wack, Lovesickness, p.98.
139
included anxiety, confusion, dry and sunken eyes, loss of appetite, sallow skin and a
disordered pulse.28
This medical view of erotic desire informs the representation of the lovesick
patient in romance literature. In Geoffrey Chaucer’s ‘The Knight’s Tale’, the exiled
Arcite pines in Thebes for his beloved, Emelye, ensconced in her garden in Athens.
Chaucer’s description of the extreme bodily and mental effects of his longing
incorporate the typical symptoms of amor hereos, outlined in medical treatises:29
His slep, his mete, his drynke, is hym biraft,
That lene he wex and drye as is a shaft;
His eyen holwe and grisly to biholde,
His hewe falow and pale as asshen colde,
And solitarie he was and evere allone,
And waillynge al the nyght, makynge his mone;
And if he herde song or instrument,
Thanne wolde he wepe, he myghte nat be stent.
So feble eek were his spiritz, and so lowe,
And chaunged so, that no man koude knowe
28
See, for instance, the account of lovesickness by Gerard of Berry, Glosses on the
Viaticum, in Wack, Lovesickness, pp.199-205. See also O’Boyle, Art of Medicine,
p.122.
29
On the representation of lovesickness in ‘The Knight’s Tale’, see D.W Robertson, A
Preface to Chaucer: Studies in Medieval Perspectives (Princeton: Princeton Uuniversity
Press, 1962), pp.145-60; Massimo Ciavolella, ‘Mediaeval Medicine and Arcite’s Love
Sickness’, Florilegium, 1 (1979), 222- 41; Edward C. Schweitzer, ‘Fate and Freedom in
“The Knight’s Tale”’, Studies in the Age of Chaucer, 3 (1981), 13-45; Jamie C. Fumo,
‘The Pestilential Gaze: From Epidemiology to Erotomania in The Knight’s Tale’,
Studies in the Age of Chaucer, 35 (2013), 85-136; Jacqueline Tasioulas, ‘“Dying of
Imagination” in the First Fragment of The Canterbury Tales’, Medium Aevum, 82:2
(2013), 213-35.
140
His speche nor his voys, though men it herde.
And in his geere for al the world he ferde
Nat oonly lik the loveris maladye
Of Hereos, but rather lyk manye,
Engendred of humour malencolik
Biforen, in his celle fantastic.30
Whereas the depiction of lovesickness in terms of physical and behavioural alterations
is common in romance narratives, Chaucer’s extended list of symptoms, in this passage,
makes explicit its grounding in contemporary medical learning. The mention of
‘hereos’, along with the mania it causes (located in the front cell of the brain, which, it
was believed, controls the imaginative faculty), conveys not only the effects of
lovesickness but also gestures to an intricate knowledge of its internal, physiological
causes. However, in ‘The Knight’s Tale’ and romance narratives, more generally, this
medicalised lovesickness is subsumed in the capacious narrative of courtly love. Thus,
although the cousins, Palamon and Arcite, suffer the physical and mental effects
resulting from their mutual love of Emelye, their submission to the rules of martial
combat, as well as their exclusive allegiance to, and idealisation of, her, exemplify this
highly regulated and codified doctrine of love.31 Because the courtly lover was meant to
30
The Canterbury Tales, in RC, I, 1361-76. Quotations from the Canterbury Tales will
be hereafter cited by fragment and line number in the text. Whilst Chaucer’s source for
‘The Knight’s Tale’, Giovanni Boccaccio’s Il Teseida, provides a similar list of lovesick
ailments, it does not include the references to amor hereos or the imaginative cell in the
brain. See Giovanni Boccaccio, The Book of Theseus: Teseida delle nozze d’Emilia,
trans. by Bernadette Marie McCoy (Sea Cliff, NY: Teesdale Publishing Associates,
1974), Book IV, lines 26-29.
31
Ideas pertaining to courtly love in the later Middle Ages were indebted to Ovid’s (43
BCE – 17/18 CE) mock-serious works Ars amatoria and Remedia amoris and Andreas
141
suffer for his lady, the medicalised perspective of love could be accommodated within
the idea of courtly love. However, its formal and performative dimensions could also be
held in tension with the medical perspective and its privileging of bodily imperatives.
Capellanus’s (fl.1180-1190) De amore. For a collection of classical and medieval works
germane to the development of courtly love, see The Courtly Love Tradition, ed. by
Bernard O’Donoghue (Manchester: Manchester University Press, 1982). For debates on
the accuracy of critical understandings of courtly love, particularly arising from C.S.
Lewis’s, The Allegory of Love: A Study in Medieval Tradition (London: Humphrey
Milford, 1938), see D.W. Robertson, Jr., ‘Courtly Love as an Impediment to the
Understanding of Medieval Texts’, in The Meaning of Courtly Love: Papers of the First
Annual Conference of the Center for Medieval and Early Renaissance Studies, State
University of New York at Binghamton, March 17-18, 1967, ed. by F.X. Newman
(Albany: State University of New York Press, 1968), pp.1-18; Henry Ansgar Kelly,
Love and Marriage in the Age of Chaucer (Ithaca, NY and London: Cornell University
Press, 1975); Roger Boase, The Origin and Meaning of Courtly Love: A Critical Study
of European Scholarship (Manchester: Manchester University Press, 1977); R. Howard
Bloch, Medieval Misogyny and the Invention of Western Romantic Love (Chicago and
London: University of Chicago Press, 1991); Jacquart and Thomasset, Sexuality and
Medicine, pp.87-115. For more recent appraisals of courtly love and its debates, see
Sarah Kay, ‘Counts, Clerks and Courtly Love’, in The Cambridge Companion to
Medieval Romance, ed. by Roberta L. Krueger (Cambridge and New York: Cambridge
University Press, 2000), pp.81-96; James A. Schultz, Courtly Love, the Love of
Courtliness and the History of Sexuality (London and Chicago: University of Chicago
Press, 2006); Jennifer G. Wollock, Rethinking Chivalry and Courtly Love in the Middle
Ages (Santa Barbara: Praeger, 2011).
142
This taut discursive relationship is itself interrogated in Chaucer’s Troilus and
Criseyde. In one telling exchange between the love-struck Troilus and Pandarus, his
fickle or self-serving advisor, the rupture between the patient’s internal experience of
illness and its manifestation is asserted. Arranging a first meeting between Troilus and
his beloved, Criseyde, at the house of Deiphebus (Troilus’s brother), Pandarus
encourages Troilus to feign illness so that he can retire to a private chamber, and so help
orchestrate the private encounter. Troilus responds:
Quod Troilus, ‘Iwis, thow nedeles
Conseilest me that siklich I me feyne,
For I am sik in ernest, douteles,
So that wel neigh I sterve for the peyne’.
Quod Pandarus, ‘Thow shalt the bettre pleyne,
And hast the lasse need to countrefete,
For hym men demen hoot that men seen swete’.32
Troilus’s affirmation, ‘I am sik in ernest’, is undercut by Pandarus’s positive reply that
this will enable Troilus better to perform his sickness (by this he means that the
symptoms of Troilus’s secret lovesickness will be enough to convince the household
that he has a fever). Pandarus understands that it is the pose of sickness, not its physical
reality, which is most important in advancing Troilus’s cause of winning Criseyde. His
aphorism, ‘for hym men demen hoot that men seen swete’, insists that bodily signs can
reveal internal, subjective symptoms. However, the fact that Pandarus is encouraging
32
Troilus and Criseyde, in RC, Book II, 1527-33. Book and line number from Troilus
and Criseyde are cited parenthetically hereafter.
143
Troilus to ‘countrefete’ his condition indicates its emphasis: it is not simply that those
who sweat are hot, but that men deem it to be so.33
The articulation of lovesickness through gestural efficacy is a key feature of the
gender dynamics central to courtly love. One of its central tropes, that of the female
exerting sexual power over the pining and servile knight, suggests a corresponding
reversal of late medieval gender hierarchies. But the configuration of lovesickness as a
disease almost exclusively suffered by young, aristocratic males implies that this
reversal remains oriented towards emphasising male dominance.34 Mary Wack and
Dana E. Stewart both argue that, in romance narratives, subjectivity was usually denied
to the lady and that she was instead accorded the role as passive functionary for the
expression of male desire.35 Wack notes that ‘Amor hereos mediated between a
33
Pandarus’s advice to Troilus to feign illness echoes the biblical account of Amnon’s
desire for his half-sister, Thamar in the Book of Kings; Amnon’s friend, Jonadab,
counsels him to pretend he his ill and to send for Thamar to care for him (WB, 2 Kings
13.1-6). A duplicitous perspective towards lovesickness can also be found in an Old
French translation of Ovid’s Ars amatoria, where the lover is advised to feign the signs
of lovesickness whilst claiming that he is close to death. See, L’Art d’amours, trans. by
Lawrence B. Blonquist (New York and London: Garland, 1987), pp.38 and 67-9.
34
Although certain medical writers, such as Peter of Spain (c.1215-1277), did consider
women as susceptible to lovesickness, the majority attributed it to noble men. See Peter
of Spain, Questiones super viaticum, A and B, in Wack, Lovesickness, pp.212-52.
35
Wack, Lovesickness, pp.166-73; Dana E. Stewart, ‘Languishing Lovers in the Court
of Frederick II’, in The Arrow of Love: Optics, Gender and Subjectivity in Medieval
Love Poetry (Cranbury, NJ, Mississauga, ON and London: Associated University
144
perceived social ideal of desire for an idealized woman whom one served and the
contradictory social and psychological reality of her inferiority’.36 The narrative of the
lover’s sickness opened up a temporary space where the lover-knight could be portrayed
as weak and subservient, but ultimately reverted to affirm the conventional order. Thus,
Troilus’s abject lovesickness, despite rendering him languid in the domestic sphere,
exerts no negative influence on his ability to fight (indeed, we are told he improves as a
result of his desire (I, 470-83)). Despite the reader’s privileged insight into Troilus’s
turmoil, Chaucer makes clear that his social persona, characterised by military might
and imperviousness, remains intact within the Trojan world, outside of the private
enclosed sphere that the poem is most concerned with. This suggests that the loverknight’s passivity is something that can only be enacted within a liminal or marginal
realm.
In this sense, the patient, as represented in the formal encounter with a practitioner
such as Benventus, is connected with the lovesick knight in romance literature. Both
occupy a medial or temporary realm involving the reversal of their usually powerful
status. Their suffering is connected with transcendence: the medical subject stands to
benefit spiritually from his fortitude; the lover is ennobled by his successful adoption of
Presses, 2003), pp.49-80; Katja Altpeter-Jones, ‘Love Me, Hurt Me, Heal Me: Isolde
Healer and Isolde Lover in Gottfried’s “Tristan”’, The German Quarterly, 82:1 (2009),
5-23 (p.8). Whilst the complex figure of Criseyde problematises this model, it is
exemplified in Emelye in ‘The Knight’s Tale’, as well as a character like Polyxena, in
John Lydgate’s Troy Book, see Lydgate, Troy Book: Selections, ed. by Robert R.
Edwards (Kalamazoo, MI: Medieval Institute Publications, 1998).
36
Wack, Lovesickness, p.171.
145
courtly behaviour. Most saliently, both are connected through the display or
performance of a certain mode of subjectivity. This performance is as much to do with
the patient’s posture as his display of suffering and pain. In Benventus’s text the
patient’s submission is revealed through his adoption of the seated or recumbent
positions, in accordance with the surgeon’s commands; it is also related to his
temporary abnegation from worldly activity. In Troilus and Crisyede, Pandarus’s advice
is a parodic inversion of the kind of authority and moral counselling offered by the
medical practitioner (indeed, Pandarus, in advising Troilus, refers to himself as
Troilus’s ‘leche’ on a couple of occasions (I, 857; II, 571). Like Benventus, he instructs
Troilus, ‘down in thi bed the leye […], And ly right there, and byd thyn aventure’ (II,
1517-19).37 The bed functions as a signifier of the protagonist’s temporary physical
inabilities, and of his retreat from the political and martial spheres. It constitutes a realm
where he is afforded space to wallow in his turmoil and subvert his usual masculine
identity. Again, this corresponds with the aristocratic patient invoked in medical
writings, whose temporary abstention from daily life, and whose opportunity to take on
a humble, deferential subjectivity, affords him transcendental possibilities. The medical
patient and romance hero are thus connected through the constitution of sickness in
terms of gesture and performance, most notably, through the temporary reversal from a
powerful masculinity to a subservient and passive mode of suffering. Whilst this
suffering might be seen to arise ineluctably from a physical condition, it is negotiated
according to specific cultural requirements and expectations.
37
This also echoes Jonadab’s advice to Amnon to feign illness in order to win Thamar
in the Book of Kings: ‘Ly vpon thi bedde, and feyn sijknes’, in WB, 2 Kings 13: 5.
146
Mysticism and the Female Patient
The language which frames the experiences of the courtly lover, with its mixture of
suffering and exaltation, is indebted to (but can also be seen to have exerted an
influence upon) mystical articulations of the divine. The blending of erotic love and
mystical desire in late medieval devotional writings emerged from the tradition of
exegesis of the Song of Songs, the enigmatic biblical book which articulates amorous
desires through sensual imagery.38 By the twelfth century, theologians such as Bernard
of Clairvaux (1090-1153) interpreted Songs as an expression of divine love for the
Church or the human soul, and this informed the development of mystical treatises
throughout the later Middle Ages.39 Such works conceived of the amore langueo of
Songs as a spiritual and virtuous analogue to fleshly desires, characterised by vice and
38
Origen was the first to produce a substantial allegorical interpretation of Songs. See
Mark W. Elliot, The Song of Songs and Christology in the Early Church (Tübingen:
J.C.B. Mohr, 2000), pp.15-18. For the significance of Songs in medieval culture, see
Ann W. Astell, The Song of Songs in the Middle Ages (Ithaca, NY: Cornell University,
1990); E. Ann Matter, The Voice of my Beloved: The Song of Songs in Western
Medieval Christianity (Philadephia, PA: University of Pennsylvania Press, 1990);
Richard Alfred Norris, ed., The Song of Songs: Interpreted by Early Christian and
Medieval Commentators (Grand Rapids, MI and Cambridge: William B. Eerdmans
Publishing Co., 2003).
39
Bernard of Clairvaux, On the Song of Songs, Vols 1-2, trans. by Killian Walsh
(Kalamazoo, MI: Cistercian Publications, 1981).
147
sin.40 They also articulated gender reversals where the male author would assume the
role of the feminised spouse of Christ. Following Constantinus Africanus’s outline of
lovesickness in the Viaticum, theologians such as William of Auvergne (c.1180-1249)
and Hugh of St. Cher (c.1200-1263) ‘adopted the new, more technical medical
discussions of lovesickness to illuminate the workings of mystical rapture’.41
Conversely, mystical devotion to Christ and the Virgin Mary transmitted easily into the
idealised love emblematic of courtly discourse.42
From the thirteenth century women devotees such as St. Clare of Assisi (11941253) and Gertrude the Great (1256- c.1302) began to participate in the previously male
tradition of commentaries on Songs.43 The fourteenth and fifteenth centuries saw an
40
See Jean Leclerq, Monks and Love in Twelfth-Century France: Psycho-Historical
Essays (Oxford: Clarendon Press, 1979), pp.27-61.
41
Wack, Lovesickness, p.23. On theological views of the relationship between eros and
mystical desire, see Dyan Elliot, ‘The Physiology of Rapture and Female Spirituality’,
in Medieval Theology and the Natural Body, ed. by Peter Biller and A.J. Minnis
(Woodbridge and Rochester, NY: Boydell Press, 1997), pp.141-74 (pp.147-48).
42
For discussion of Christological associations in courtly love narratives, see Deborah
Rose-Lefmann, ‘Lady Love, King, Minstrel: Courtly depiction of Jesus or God in LateMedieval Vernacular Mystical Literature’, in Arthurian Literature and Christianity:
Notes from the Twentieth Century, ed. by Peter Meister (New York: Garland Pub.,
1999), pp.141-61; Stewart, ‘Languishing Lovers’, p.74.
43
See E. Ann Matter, ‘Medieval Interpretations of Song of Songs’, in Women and
Gender in Medieval Europe: An Encyclopedia, ed. by Margaret C. Schaus (New York
and Oxon: Routledge, 2006), pp.769-70.
148
increase in articulations of female piety in texts written by and about women mystics,
often operating outside of specific religious orders, and addressed to a female
readership. This development of an individual, intense and expressive female
spirituality, in line with a rise in literacy amongst aristocratic women, led to the
circulation of much devotional material written for women.44 English works like the
Showings of Julian of Norwich and the Book of Margery Kempe appropriated
established devotional models for a lay, female audience. Such texts incorporated
descriptions of visionary experience and appropriated the established mystical and
courtly registers in their professions of affective devotion to Christ.45 Given the
44
Mary C. Erler, Women, Reading and Piety in Late Medieval England (Cambridge and
New York: Cambridge University Press, 2002); Ann Clark Bartlett, Male Authors,
Female Readers: Representation and Subjectivity in Middle English Devotional
Literature (Ithaca, NY and London: Cornell University Press, 1995); Annette C. Grise,
‘Women’s Devotional Reading in Late Medieval England and the Gendered Reader’,
Medium Aevum, 71:2 (2002), 209-225; Nicola McDonald, ‘Chaucer’s Legend of Good
Women, Ladies at Court and the Female Reader’, Chaucer Review, 35:1 (2000), 22-42;
Jennifer N. Brown, ‘Introduction’, in Three Women of Liège: A Critical Edition of and
Commentary on the Middle English Lives of Elizabeth of Spalbeek, Christina Mirabilis,
and Marie d’Oignies, ed. by Jennifer N. Brown (Turnhout: Brepols, 2008), pp.1-25
(pp.18-22).
45
Critics have debated the extent to which mystical texts authored by, or concerning,
women can or should be distinguished from ones written by men. E. Ann Matter argues
that the penning of commenatries on Songs by thirteenth-century women was defined
by their participation within a masculine and authoritative discourse. See Matter,
‘Medieval Interpretations’, pp.769-70. Rosalynn Voaden’s identification of a medieval
149
masculine co-ordinates of the lovesick or languishing patient, to what extent did
mystical writings featuring descriptions of female piety incorporate the figure of the
patient?
The question addresses a radical distinction between male and female illness in
medieval culture. The hierarchical basis of this difference, reinforced by medical theory,
meant that women’s illnesses tended not to be connected with spiritual transcendence.46
The imputed physical inferiority of women was afforded a uterine basis, in medical
distinction between mystical and visionary experiences informs her argument that a
masculine form of devotional writing was privileged over a feminine one. She argues
that mystical experiences, associated with men and characterised by an inward, nonsensory understanding of the presence of God, took cultural precedence over visionary
ones, linked to women, and often cast in a negative light by clerics and Church
authorities. See Rosalynn Voaden, God’s Words, Women’s Voices: The Discernment of
Spirits in the Writings of Late-Medieval Women Visionaries (Woodbridge and
Rochester, NY: York Medieval Press, 1999), pp.9-17. Conversely, Caroline Walker
Bynum and Meri Heinonen argue that both forms of experience are articulated in
writings attributed to female and male authors. See Bynum, Holy Feast, p.105, and Meri
Heinonen, ‘Henry Suso and the Divine Knighthood’, in Holiness and Masculinity, ed.
by P.H. Cullum and Katherine J. Lewis, pp.79-92 (pp.79-91).
46
For a view of how medical physiology conditioned perspectives of female spirituality,
see Elizabeth Robertson, ‘Medieval Medical Views of Women and Female Spirituality
in the Ancrene Wisse and Julian of Norwich’s Showings’, in Feminist Approaches to the
Body in Medieval Literature, ed. by Linda Lomperis and Sarah Stanbury (Philadelphia:
University of Pennsylvania Press, 1993), pp.142-67.
150
theory, manifested in the idea of the ‘wandering womb’, the belief that many illnesses
in women were attributable to a displaced uterus.47 The expression of such ideas in late
medieval gynaecological texts such as the Trotula, a collection of writings attributed in
the later Middle Ages to Trotula de Ruggiero, blended Galenic theory with the narrative
of the creation of Eve in the Book of Genesis.48 The dissemination of the Trotula
throughout late medieval Europe in Latin and vernacular translations illustrates how
women’s illnesses were becoming ever-increasingly of interest to male practitioners and
writers.49 But the construction of women in these writings, in terms of ‘voracious sexual
appetites and mysterious physiological processes’, suggests that the female patient was
perceived by medical authorities in terms of danger and disorder, in contrast to the ideal
terms with which the male patient tended to be outlined.50
47
See Lindgren, The Wandering Womb, and Monica Green, ‘Introduction’, in The
Trotula: An English Translation of the Medieval Compendium of Women’s Medicine,
ed. and trans. by Monica Green (Philadelphia: University of Pennsylvania Press, 2002),
pp.14-50.
48
On the historically elusive figure of Trotula de Ruggiero, or Troula of Salerno, and
the dabtes surrounding her existence and/or authorship of the gynaecological texts, see
Rowland, ‘Exhuming Trotula’, and Cadden, pp.169-248. Monica Green argues that the
Trotula texts had instead a male author(s). See Green, Women’s Medicine, pp.29-69.
49
Monica H. Green, ‘Moving from Philology to Social History: The Circulation and
Uses of Albucasis’s Latin Surgery in the Middle Ages’, in Between Text and Patient:
The Medical Enterprise in Medieval & Early Modern Europe, ed. by Florence Eliza
Glaze and Brian Nance (Florence: SISMEL, 2011), pp.331-72 (p.364).
50
Green, Women’s Medicine, p.25.
151
The preface to a late medieval translation of one of the books of the Trotula,
entitled The Sekenesse of Wymmen, reveals some of the problematical features attending
the representation of women’s illnesses in public discourse:
And thowgh women have diuers evelles & many greet greuaunces mo than all
men knowen of, as I seyd, hem schamen for drede of repreving in tymes comyng
& of discuryng off vncurteys men þat loue women but for her lustes and for her
foule lykyng. And yf women be in dissese, suche men haue hem in despyte &
thenke nought how moche dysese women haue or þan they haue brought hem into
þis world. And therfore, in helping of women I wyl wright of women prevy
sekenes the helpyng, and that oon woman may helpe another in her sykenesse &
nought diskuren her previtees to suche vncurteys men.51
This passage reiterates the dominant view of women being consistently beset by
illnesses, insisting that they have more ailments, as well as a greater variety of them,
than men do. Whereas the emphasis in medical deontology, with its focus on the
hypothetical male patient, is on the navigation of the power dynamics between
practitioner and patient, the question of secrecy and disclosure is prioritised here. Thus,
women cannot reveal their sicknesses for fear of being despised by ‘vncurteys men’.
Despite the different emphases between this preface and those in the more general
treatises, both are concerned with the issue of performance. The employment of the
term, ‘vncurteys’, with its associations with romance narratives and courtesy guides,
articulates women’s illness and its representation in terms of behavioural etiquette and
moral imperatives.52 The preface states that this treatise offers a private, reciprocal
space, in contrast to the public realm, where ‘oon woman may helpe another in her
51
Medieval Woman’s Guide to Health: The First English Gynecological Handbook, ed.
by Beryl Rowland (Kent, OH: Kent State University Press, 1981), p.58.
52
On courtesy guides, see Norbert Elias, The Civilizing Process: The History of
Manners, trans. by Edmund Jephcott, Vol. I (Oxford: Blackwell, 1978).
152
sykenesse’. However, the iteration of this promise of intimacy is offset by the accessible
textual medium through which the assurance is enunciated. This is especially so in light
of the male readership which gynaecological texts attracted in the late medieval period.
The rhetorical quality of this preface suggests, then, that the female patient, like her
male counterpart, is configured in terms of performance; yet this performance is here
invested in ideas of secrecy and shame.
The spiritual autobiography of Margery Kempe (b. c.1373, d. in or after 1438), the
fifteenth-century Norfolk devotee, businessewoman and housewife, constitutes an
example of a female mysticism, often filtered through images and references to illness.53
However, Margery’s status as patient, in line with her general spiritual devotion, is
often beset with social friction and public expressions of disgust.54 This can be seen in
the hostile reaction, at one point, to her decision to dress in white clothing, as a sign of
her spiritual purity. Her endurance of torments by the affronted people of her hometown
of Lynn is described in terms of a blurring between physical illness and spiritual
53
Margery Kempe may be seen in terms of the consumption, as well as the authorship,
of mystical material: her Book makes reference to her acquaintance, ostensibly via her
redactor, with the vita of Marie d’Oignies and the writings of the English mystic,
Richard Rolle (c.1305- 1349). See The Book of Margery Kempe, ed. by Sanford Brown
Meech and Hope Emily Allen, EETS o.s. no.212, Vol. I (London: Published for the
Early English Text Society by Oxford University Press, 1940), pp.152-4.
54
I follow Lynn Staley in using ‘Margery’ and ‘Kempe’ to distinguish respectively
between the literary character in the text and the historical personage and/or author. See
Lynn Staley, ‘The Trope of the Scribe and the Question of Literary Authority in the
Works of Julian of Norwich and Margery Kempe’, Speculum, 66 (1991), 820–38.
153
beneficence. Margery’s response to her persecution is to cry loudly to the consternation
of her tormentors, who decry her as both evil and sick:
Sum seyde þat sche had þe fallyng euyl, for sche wyth þe crying wrestyd hir body
turnyng fro þe o syde in-to þe oþer & wex al blew & al blo as it had ben colowr of
leed. & þan folke spitted at hir for horrowr of þe sekenes, & sum scornyd hir and
seyd þat sche howlyd as [had] ben a dogge & bannyd hir & cursyd hir & seyd þat
sche dede meche harm a-mong þe pepyl.55
Her reaction to her tormentors, typified by her crying and convulsive bodily movement,
would appear to be in stark contrast to the usual submissive and reticent attributes of the
patient. Her imputed sickness, the falling evil (usually glossed as epilepsy by modern
commentators), was a common feature of medieval medical taxonomies; it was
sometimes adopted by religious writers as a sign of moral abasement due to its lapsarian
resonances.56 It is constituted similarly in this passage through its connection to the
townspeople’s condemnation of Margery’s attempts to reclaim her virginity. However,
55
Kempe, Book of Margery Kempe, p.105.
56
The fourteenth-century Northumbrian poem, Cursor Mundi, for instance, lists the
falling illness as one of a list of diseases suffered by the biblical King Herod to signify
his degenerate character. See Cursor Mundi: The Cursur O the World: A Northumbrian
Poem of the Fourteenth Century in Four Versions, ed. by Richard Morris, EETS o.s.
nos.57, 59, 62, 66, 68, 99 (London: Published for the Early English Text Society by K.
Paul, Trench, Trübner and Co., 1874-92), p.678, l.11831. Online version at ‘Corpus of
Middle English Prose and Verse’ (Ann Arbor, MI: University of Michigan Press, 2006)
http://quod.lib.umich.edu/c/cme/AJT8128.0001.001/1:4.1.78?rgn=div3;view=fulltext
[accessed 5 December 2014]. See above for discussion of images of the falling evil in
the Stockholm Roll.
154
her abject status is one that seems to offer for her a desirable subjectivity. The abuse
which her behaviour and complexion provokes in those around her, such as spitting, is
described in language that evokes staple descriptions of Christ’s Passion in late
medieval devotional literature.57 The striking image of Margery’s body swelling up and
becoming discoloured, amplified by the alliterative ‘blew’ and ‘blo’ (signifying the
purple and blue coloration of bruising), evokes a legion of affective accounts of Christ’s
disfigurement in the Passion.58 Her abject status, inflected through a moral and physical
illness, is presented similarly as affording spiritual opportunities. Although she cries and
convulses, Margery accepts her condemnation, ‘pacyently for owr Lordys lofe, for sche
wist wel þat þe Iewys seyd meche wers of hys owyn persone þan men dede of hir’.59
Her experience of being pathologised by the community allows her representation as a
persecuted Christ-like figure; the disgust which her imputed sickness provokes in the
57
See Gail McMurray Gibson, The Theater of Devotion: East Anglian Drama and
Society in the Late Middle Ages (Chicago and London: University of Chicago Press,
1989), pp.47-65.
58
For example, a Middle English version of the highly influential affective account of
Christ’s life, Pseudo-Bonaventura’s Meditationes Vitae Christi, describes Christ’s face
during the Passion: ‘His face wex bliech, his lippes bloo’. See Meditations on the Life
and Passion of Christ, ed. by C. D'Evelyn, EETS o.s. no.158 (London: Published for
Early English Text Society by Oxford University Press, 1921), p.18, l.641.
59
Kempe, Book of Margery Kempe, p.105.
155
community also becomes a means by which she can establish an exemplary
spiritualism.60
Margery’s status as patient is thus forged through conflict and banishment: her
outcast position is a means for her to access the opportunities which, Kempe implies,
are meant to be denied to her by the people of Lynn. In fact, her experiences of illness,
described at various points in the Book, shows that her achievement of the transcendent
spiritual opportunities afforded by being a ‘patient’ is a vexed process. These illnesses
are linked to her maternity, echoing the close associations between women’s sickness
and childbirth in the gynecological treatises. The narrative of Margery’s life begins with
her marriage at twenty and subsequent pregnancy which, we are told, was a difficult
one:
And aftyr þat sche had conceyued, sche was labowrd wyth grett accessys tyl þe
chyld was born, & þan, what for labowr sche had in chyldyng & for sekenesse
goyng beforn, sche dyspered of hyr lyfe, wenyng sche mygth not leuyn. And þan
sche sent for hyr gostly fadyr, for sche had a thyng in conscyens whech sche had
neuyr schewyd be-forn þat tyme in alle hyr lyfe.61
60
The ‘pathologisation’ of Margery Kempe is not restricted to her neighbours; it
constitutes an abiding response to the Book by critics. For some examples, see H.
Thurston, ‘Margery the Astonishing’, The Month, 2 (1936), 446-56; David Knowles,
The English Mystical Tradition (London: Burns and Oates, 1964), pp.147-9; C.W.
Atkinson, Mystic and Pilgrim: The Book and the World of Margery Kempe (Ithaca, NY:
Cornell University Press, 1983), pp.195-220; Richard Lawes, ‘The Madness of Margery
Kempe’, in The Medieval Mystical Tradition in England, Wales and Ireland: Papers
read at Charney Manor, July 1999: Exeter Symposium VII, ed. by Marion Glascoe
(Cambridge: D.S. Brewer, 1999), pp.147-67.
61
Kempe, Book of Margery Kempe, pp.6-7.
156
Margery believes that she is close to death, as the result of both the ‘labowr’ of her
illness and that of childbirth. Her ‘grett accessys’ could indicate any of a number of
ailments: the term ‘accesse’ was often used to describe periodic attacks of a fever-like
illness; it was also employed by authors, like Chaucer (Troilus and Criseyde, RC, II,
1315), to signify lovesickness or emotional intensity. The indeterminacy of Margery’s
illness, then, possessing both physical and emotional connotations, parallels the
unconfessed but significant ‘thing’ in her conscience, which is not revealed to the
reader. Sickness, childbirth and sin are overlaid in this passage and inform her fear of
dying without absolution.
This combination of illness and divine punishment is intensified after her delivery
when we are told that she went ‘owt of hir mende & was wondyrlye vexid & labowryd
wyth spyritys half ȝer viii wekys & odde days’.62 During this period she perceives
herself to be tormented by devils and is driven to bite her hand and violently tear at her
skin with her nails. Her health is finally restored when Jesus appears to her,
in lyknesse of a man, most semly, most bewtyuows, & most amyable þat euyr
mygth be seen wyth mannys eye, clad in a mantyl of purpyl sylke, syttyng up-on
hir beddys syde, lokyng vp-on hir wyth so blyssyd a chere þat sche was
strengthyd in alle hir spyritys.63
Margery’s illness, then, follows an arc not dissimilar to the way that the patient-figure is
constructed in medical treatises and lovesickness accounts. In all cases, sufferers,
confined to their beds and undergoing painful physical or emotional conditions, are
linked to spiritual fervour or transcendence. The presence of Christ at Margery’s
62
Kempe, Book of Margery Kempe, p.7.
63
Kempe, Book of Margery Kempe, p.8.
157
bedside as a friendly and beautiful man highlights again the structural correspondences
between desire in romance narratives and in mystical writings.
Nonetheless, what distinguishes this description from the usual portrayals of the
aristocratic, male patient is the way that Margery’s illness is indexed to her role as
housewife. Whereas the patient-identity, in medical and romance literature, is connected
with the suspension of a subject’s normal, quotidian roles and responsibilities,
Margery’s illness relates to her commitment to the domestic realm and her submission
to a patriarchal order. Her resistance to an exclusive adoption of this role is made
through her allegiance to Christ and her visionary inner life.64 The incorporation of
illness within articulations of this resistance is revealed at pivotal points of her spiritual
development: her ‘out of mind’period follows her initiation into the domestic sphere,
signalled by her marriage and the birth of her first child; it ends with the first of her
intense encounters with Christ;65 later, the birth of her last child is also followed by
physical and spiritual weakness, and leads to her decision (again inspired by Christ), to
reveal her visions to a vicar in Norwich.66 As Liz Herbert McAvoy argues, Margery’s
‘spiritual development is clearly founded on the physical experiences of being a wife
and a mother within a gender-conscious society’.67 Indeed, Kempe further suggests such
64
Liz Herbert McAvoy, Authority and the Female Body in the Writings of Julian of
Norwich and Margery Kempe (Cambridge: D.S. Brewer, 2004), pp.28-9.
65
For a reading that emphasises the importance of the theme of domesticity in the Book,
see Deborah Ellis, ‘Margery Kempe and the Virgin’s Hot Caudle’, Essays in Arts and
Sciences, 14 (1985): 1-11.
66
67
Kempe, Book of Margery Kempe, p.38.
McAvoy, ‘Authority and the Female Body’, p.30.
158
an identity by specifying her worship in the Gesine (‘childbed’) Chapel, in her local
parish church of St. Margaret’s at Lynn, which housed an image of the Nativity.68 The
account of Margery’s spiritualism thus draws on her maternal and domestic life, but it is
also in perpetual tension with the expectations that this role would impose upon her. Her
configuration as a patient is rooted in her domestic life, in her postpartum weaknesses
and illnesses; but it is also employed to indicate her imitation of, and affective empathy
with, Christ.69 Her achievement of the spiritual transcendence that is embedded in the
idea of the patient is therefore represented in the Book as a much more fraught and
complex endeavour than it is in depictions of the idealised, male patient.
The Virgin and Christ as Patients: Exemplarity and Abasement
The construction of the patient necessarily invokes an observer: some agent, a
practitioner, priest, reader or audience, must see the patient and be engaged, provoked,
instructed, edified or repulsed. For the male patient, in his various late medieval
incarnations, the observer is the surgeon, counsellor, reader, or, in the case of the
lovesick patient, the beloved. Conversely, a female devotee, like Margery Kempe,
68
Kempe, Book of Margery Kempe, p.55. For discussion of the Gesine chapel, see
Gibson, Theater of Devotion, p.64.
69
Laurinda S. Dixon points to the ways that Christian writers reinterpreted ancient
gynaecology to emphasise ‘marriage and motherhood as socially-mandated ways for
women to attain and maintain their health’. See Dixon, ‘The Curse of Chastity: The
Marginalization of Women in Medieval Art and Medicine’, in Matrons and Marginal
Women in Medieval Society, ed. by Robert Edwards and Vickie Ziegler (Woodbridge:
Boydell Press, 1995), pp.49-74 (p.72).
159
endeavouring to access spiritual communion, is regarded by her neighbours with
disgust. We have seen how the preface writer of The Sekenesse of Wymmen constructs
the female patient in terms of eluding the gaze of uncourteous men, yet, in doing so,
renders her illness in terms of secrecy and humiliation. This is also true of PseudoAlbertus Magnus’s, De Secretis Mulierum, or The Secrets of Women, a text written for a
male readership and popular throughout the later Middle Ages.70 Its inclusion of
sections detailing how to establish a woman’s virginity, through inspections of
menstrual blood and urine, constitutes the female body, paradoxically, as arcane yet
knowable. It reinforces the physical facts of virginity with spiritual signs, including
modesty, shame and fear, thus underlining the ‘porous boundaries between gynaecology
and theology’.71 Such a text, in establishing a ‘semiotics of virginity’, not only proposes
that the secretive female body is legible, but by offering a means to enable this, it
stipulates that it should be read.72 The patient’s body is here privileged as the site of
verification of a spiritual status.
70
Pseudo-Albertus Magnus, Women’s Secrets: A Translation of Pseudo-Albertus
Magnus’ De Secretis Mulierum with Commentaries, trans. and ed. by Helen Rodnite
Lemay (Albany, NY: State University of New York Press, 1992).
71
Sarah Allison Miller, Medieval Monstrosity and the Female Body (New York and
London: Taylor and Francis, 2010), p.65. For other analyses of medieval medicine,
religion and virginity, see Kathleen Coyne Kelly and Marina Leslie, eds., Menacing
Virgins: Representing Virginity in the Middle Ages and the Renaissance (Newark and
London: Associated University Presses, 1999); Green, Women’s Healthcare; Lochrie,
Covert Operations, pp.93-134.
72
Miller, Medieval Monstrosity, p.63.
160
Representations of the Virgin Mary in accounts and scenes of the Nativity are
similarly predicated on the performance of the maternal and sanctified female body as a
means to affirm the doctrine of the virgin birth. The Nativity thus instigates the
transformation of an exemplary patient from physical abasement to spiritual perfection.
Its antithetical range is underlined by the opposition between the archetypal figure of
disorder and marginality (according to dominant medical and moral perspectives), the
parturient woman, and the exemplar of spiritual privilege and sanctity, the Virgin Mary.
This inversion is foregrounded to privilege divine truth over worldly knowledge and
authority. Late medieval images of the Nativity bring together the ideas of Mary as
divine agent and human sufferer. She is often pictured lying in bed, holding the infant
Christ, or close to his manger. A late fourteenth-century English altarpiece panel shows,
for example, Mary sitting up in bed presenting Christ to the viewer (fig.9). The scene
follows orthodox medieval representations of the Nativity through its inclusion of the
figures of Joseph, a grazing cow, a manger and midwife. Yet the image also includes
components typical of an aristocratic birthing environment of the later Middle Ages.
This space was arranged according to various practical and cultural requirements: men
were excluded from the birth chamber, so it was usually sectioned off from a hall and
screened with curtains;73 the occasion of the birth of a child (particularly a male heir)
occasioned lavish expenditure amongst wealthy aristocrats, including adornment of the
chamber with tapestries and expensive fabrics; medical theory stipulated that the
chamber should be warm, enclosed and dark for the health of both mother and baby.74
73
Elizabeth L’Estrange, Holy Motherhood: Gender, Dynasty and Visual Culture in the
later Middle Ages (Manchester: Manchester University Press, 2012), pp.1-18.
74
See Roberta Gilchrist, Medieval Life: Archaeology and the Life Course (Woodbridge:
Boydell Press, 2012), pp.134-44; Gail McMurray Gibson, ‘Scene and Obscene: Seeing
161
Thus, in this Nativity panel of carved alabaster, the hanging bed-sheet with its folds and
creases acts as a cocoon for Mary and Christ as does the canopied bed with its curtains.
Christ’s manger is very much a luxurious piece of furniture with its tasselled pillow and
rocker base. The medical injunctions of warmth and enclosure are conveyed by the
drapery and the tight and narrow space in which the inhabitants cram, as well as the
animal providing vital heat for the Christ child with its breath.75
This constitution of the biblical Nativity scene as a contemporary birthing
environment can be seen to offer clear resonances for a late medieval audience by
matching their own experiences (or knowledge) of childbirth with divine significance.
Yet these quotidian attributes grate to some extent with orthodox theological accounts
of the Nativity. This tension is evident in the presentation of the Virgin as patient, where
Mary’s two roles of domestic mother and divine and virginal saint are brought into play.
Representations of her lying in bed following her delivery of Christ signify her need for
support and rest. This motif is in some cases extended with portrayals of her (and
Joseph) as exhausted: the scene from the English altarpiece panel shows her with eyes
closed, whilst a historiated initial in a mid-fourteenth-century English Book of Hours,
The Taymouth Hours, represents both Mary and Joseph deep in slumber, their faces
and Performing Late Medieval Childbirth’, Journal of Medieval and Early Modern
Studies, 29:1 (1999), 7-24; Green, Women’s Medicine, pp.70-117.
75
Nicholas Love’s (d.1423/4) translation of Pseudo-Bonaventura’s Meditationes Vitae
Christi describes the animals providing warmth for Christ and emphasises their
awareness of the benefits of this for the child. See Love, Mirrour of the blessed lyf of
Jesu Christ: A Translation of the Latin Work entitled Meditationes Vitae Christi, ed. by
Lawrence Fitzroy Powell (Oxford: Clarendon Press, 1908), p.47.
162
turned away from the infant Jesus (fig.10). Here, the Virgin, her cheek slightly flushed
and, like Christ, swaddled in an ample blue bed-sheet, assumes the archetypal pose of
the reclining, languishing patient.
These features undermine a central theological understanding of the Nativity:
theologians such as St. Anthony of Padua (1195-1231) and St. Bonaventure (12211274) stressed that Mary’s virginity and her immaculate conception by the Holy Spirit
meant that her delivery of Christ took place without pain.76 The images of an infirm
Mary waver from such views. Crucially, the representation of the divine miracle, taking
place within a familiar and domestic setting, means that the signs of such a defining
moment as parturition cannot be readily effaced without loss of the image’s physical
and quotidian delineation. Therefore, in one sense, Mary is an exemplary patient –
composed, intact and without pain; but, in another sense, she is a physical, human one
appearing infirm, recumbent and exhausted.
However, Mary’s divine and human qualities were not simply parts of an anomaly
to be overcome by late medieval writers and illustrators; the relationship between them
was itself the focus of intense interest. The ubiquitous presence of the midwife, usually
referred to as Salome in Nativity images and accounts, shows how deliberations on
76
See Elina Gertsman, ‘Performing Birth, Enacting Death: Unstable Bodies in Late
Medieval Devotion’, in Visualizing Medieval Performance: Perspectives, Histories,
Contexts, ed. by Elina Gertsman (Aldershot: Ashgate, 2008), pp.83-104. Amy Neff has
considered the late medieval vogue for images of Mary’s swoon at the foot of the cross
and argued that many incorporate distinct features of labour pains. See Amy Neff, ‘The
Pain of Compassio: Mary’s Labor at the Foot of the Cross’, Art Bulletin, 80:2 (1998),
254-273.
163
Mary’s dual identity could be inflected through ideas of medical practice. Salome, in the
second-century apocryphal Infancy Narrative of James (or the Protoevangelium
Jacobi),77 is a mysterious figure who refuses to believe in the miracle of the Virgin birth
without proof.78 She is led into the cave, where Mary has given birth, by a midwife and,
on affirming the miracle, her hand withers. She is instructed by Mary to hold Christ and,
by touching him, her hand is healed. Although James’s gospel does not explicitly state
that Salome is a midwife, medieval Nativity narratives typically cast her as one of two
midwives who attend the cave or stable at Joseph’s behest, but arrive after Mary has
given birth. This story informs the context, then, of the conspicuous images of Salome’s
hand in both the English altarpiece fragment and the Nativity illustration in the
Taymouth Hours; whilst both images would seem to imply the provision of care, as the
midwife reaches out for the infant Christ, the Narrative of James context affirms the
opposite: she seeks healing.
The characterisation of Salome as authoritative midwife and injured penitent is a
central feature in the N-Town ‘Nativity’ play. The N-Town cycle of mystery plays dates
from the mid to late fifteenth century and is preserved in one manuscript: London, BL
MS Cotton Vespasian D.8; the plays were meant to be performed in various towns in
the East Midlands. Salome and fellow midwife, Zelome, are cast in this play in the
context of a wider theme, where the miracle of the virgin birth is offset by material
understandings of it. With the pregnant Mary ensconced in the manger, Joseph is
77
The Apocryphal New Testament: A Collection of Apocryphal Christian Literature in
an English Translation based on M.R. James, ed. by J.K. Elliot (Oxford and New York:
Oxford University Press, 1993), pp.48-67.
78
Apocryphal New Testament, pp.64-5.
164
required to leave her to her confinement. He goes in search of midwives and encounters
Salome and Zelome who agree to help. The midwives go to the stable with Joseph, but
when he enters he finds Mary smiling. At this point in the play, much dramatic tension
and comedy is achieved through the contrast of the material perspectives of Joseph and
the midwives with Mary’s divine understanding of the miracle of the birth of Jesus. Of
particular prominence is the way that the midwives’ expectation of Mary’s appearance
and behaviour, as a new mother and patient, is set against the evidence they encounter.
First, Joseph, unaware that Mary has already given birth, is dismayed at her apparent
joy when the midwives arrive:
Why do ȝe lawghe, wyff? Ȝe be to blame!
I pray ȝow, spowse, do no more so!
In happ þe mydwyuys wyl take it to grame,
And at ȝoure nede helpe wele non do. […]
Þerfor be sad, and ȝe may so,
And wynnyth all þe mydwyuis good diligens (182-9).79
The relationship between Mary, the patient, and her carers is here drawn as one of
submission. She is expected to display the right amount of suffering in order to elicit the
midwives’ attention and diligence, and this idea is encapsulated in the verb ‘wynnyth’.
The idea of the patient is once again articulated through a performance of pain and
suffering, one that can engage with the empathy, and thus the aid, of those who witness
it.
79
‘The Nativity’ in The N-Town Play: Cotton MS Vespasian D.8, ed. by Stephen
Spector, EETS s.s. no.11, Vol. I: Introduction and Text (Oxford, New York and
Toronto: Published for the Early English Text Society by Oxford University Press,
1991), pp.152-63 (line numbers are cited in the text).
165
This ignorance is predicated on Joseph’s acceptance of worldly power and
hierarchical systems. As well as the provision of care and support during and after the
birth of the child, the midwife’s role in late medieval society also included ‘a judicial
function as privileged witnesses to the circumstances of a particular birth, holding the
power, for instance, to exonerate or indict a woman accused of adultery’.80 Therefore,
Joseph’s anxieties can be understood as related to the socially important role that
midwives occupied as potential agents of spiritual or legal authority. Mary’s patientstatus is not just affirmed in terms of the care offered by the midwives, but also in
regard to her vulnerability to their potential judgement and surveillance.
Nonetheless, Joseph’s deference to worldly authority is undercut by Mary who
shows the new-born Jesus to him, prompting his instant recognition of the higher divine
authority of Jesus: ‘O gracyous childe, I aske mercy./ As þu art Lord and I but knaue,/
Forȝeue me now my gret foly’ (195-7). Joseph’s acceptance that Mary has given birth
without labour is dismissed by the midwives: ‘In byrth, trauayle muste sche nedys
haue,/ Or ellys no chylde of here is born’ (206-7). When the midwives approach Mary,
they attempt to discover the truth through touching her:
Zelomye: With honde lete me now towch and fele
Yf ȝe haue nede of medycyn.
I xal ȝow comforte and helpe ryght wele
As other women yf ȝe haue pyn.
80
Denise Ryan, ‘Playing the Midwife’s Part in the English Nativity Plays’, Review of
English Studies, 54:216 (2003), 435-448 (p.435). Although, in England, midwives were
not subject to official regulation or licensing, it was generally understood that they
would provide more than just physical care and expertise at a delivery, including, in
some cases, administering baptism. See Gibson ‘Scene and Obscene’, p.10, and
Rawcliffe, Medicine and Society, pp.194-202.
166
Maria: Of þis fayr byrth þat here is myn
Peyne nere grevynge fele I ryght non.
I am clene mayde and pure virgin;
Tast with ȝoure hand ȝoureself alon (218-25).
Their tactile inspection of the Virgin implicates medical expertise in the worldly
knowledge brought into question in the play. The Virgin’s use of the word ‘tast’, as she
invites the midwives to probe her, denotes touching; indeed, the word was often used in
Middle English in the context of a medical examination or probing. Yet, ‘tast’ could
also be used in the context of religious truth as in the Psalm verse: ‘Tasteþ and seeþ, for
sweete is þe lord’.81 It is through the direct sensuosity of touch, then, that those who
resist are invited to believe and partake in the divine economy.
However, as a result of her sceptical testing, Salome’s hand withers allowing
Mary to reverse her relationship with the midwife and assume the role of mediator or
counsellor:
Maria: As Goddys aungel to ȝow dede telle,
My chylde is medycyn for every sor.
Towch his clothis be my cowncelle,
Ȝowre hand ful sone he wyl restor (290-3).
The mention of Christ as medicine echoes an earlier promise by the midwives to
provide medical help to the Virgin. In this way, Salome’s divine punishment effects the
manifestation of Christological medicine imbued with transformative possibilities. In
this re-ordering of roles, Christ himself becomes medicine, rather than subject to the
midwife’s care. Salome’s touch is also transformed from one betokening medical
expertise, authority and rational doubt to one of faith and supplication. The scene
81
WB, Psalms 33:9.
167
affirms a hierarchy where knowledge based on purely medical principles, and
encompassing the power of authoritative surveillance, is undermined and supplanted by
divine revelation.
But the place of medicine in the play is not simply to function as part of a
hierarchy where the divine is privileged over worldly knowledge and authority. After
all, the gynaecological examination undertaken by the midwives was advanced by
medieval theologians and commentators as intrinsic components to the argument of
Mary’s virginal status. The divine miracle is subject to medical examination as a means
of consolidating its veracity, but it is undermined by this very dependence. Both Mary’s
body and the birthing environment, which it rests within, are thus ‘furiously contested
[spaces] where divine miracle and human rule meet’.82 The N-Town ‘Nativity’ play
attests to this tension by its privileging of the dramatics attending the gynaecological
examination over the miracle itself, the birth of Christ. That happens offstage whilst
Joseph is looking for the midwives. The play foregrounds instead Mary’s movement
from maternal abasement to divine authority through her confident submission and
acceptance of the role of patient. The private event of the birth environment is given
over to public display, making explicit the performative construction of the patient and
its edifying potential.
The image of the Virgin Mary reversing the authoritative relationship with the
midwives depicts the patient overcoming the restrictions of medical and worldly
understandings of suffering and health. Medicine is articulated as a means to represent
its negligibility within the divine scheme; but the persistent references to it, in the
service of validating religious truth or of elucidating the reality of suffering, testifies to
82
Gibson, ‘Scene and Obscene’, p.20.
168
its central place in such narratives. The patient-figure, with its inherent blending of a
medicalised physicality and spiritual accessibility, is therefore a pervasive presence in
late medieval writings. The appeal to the virtue of patience, central to the construction
of the medical subject, is grounded in its exemplification by Christ in the Gospels,
particularly as depicted in the events of the Passion. Late medieval representations of
Christ, typically figured as both physician and medicine, would seem to bespeak the
redundancy of worldly medicine. However, descriptions of his circumcision are
interwoven with ideas of medical healing whilst promoting him as an exemplary patient.
The representation of Christ as a patient is made explicit in a detail of the
circumcision in a 1466 German altarpiece by Friedrich Herlin (c.1425-1500); it
provides a medical context to the procedure in its depiction of surgical-like
accoutrements including a scalpel, medical flask and container. Whilst such features do
not appear to be extensive in circumcision depictions from late medieval England, a
fragment from a fifteenth-century English altarpiece bears correspondences with the
Herlin detail. Christ is here depicted sitting on a cloth-covered altar as the priest (whose
body is missing in the fragment) handles a thin knife and block as he performs the
operation; behind him, an attendant holds a dish (fig.11). Like the Herlin altarpiece, the
tableau evinces the careful delicacy of a surgical procedure. The presence of a medical
register in such images raises the question of its significance: why would late medieval
artists and sculptors have emphasised conventional surgical features in depictions of
Christ’s circumcision? An obvious reason is due to the mutual skin-cutting and bloodshedding characteristic of both procedures. Despite their resemblances, circumcision
was not believed by Christians to possess medical benefits and was viewed instead as a
169
marker of Jewish alterity.83 However, the large amount of accounts and representations
of Christ’s circumcision, along with the multiple appearances of his foreskin across
Europe from the twelfth century, shows its importance in late medieval culture.84 This
interest also hearkened back to the discussions by early Church theologians of the
symbolic importance of the circumcision in instigating Christ’s Passion. 85 The
83
Elisheva Baumgarten, ‘Circumcision and Baptism: The Development of a Jewish
Ritual in Christian Europe’, in The Covenant of Circumcision: New Perspectives on an
Ancient Jewish Rite, ed. by Elizabeth Wyner Mark (Lebanon, NH: Brandeis University
Press, 2003), pp.114-27 (p.114).
84
Robert P. Palazzo, ‘The Veneration of the Sacred Foreskin(s) of Baby Jesus: A
Documented Analysis’, in Multicultural Europe and Cultural Exchange in the Middle
Ages and Renaissance, ed. by James P. Helfers (Turnhout: Brepols, 2005), pp.155-76;
Marc Shell, ‘The Holy Foreskin; or, Money, Relics, and Judeo-Christianity’, in Jews
and Other Differences: The New Jewish Cultural Studies, ed. by Jonathan Boyarin and
Daniel Boyarin (Minneapolis: University of Minnesota Press, 1997), pp.345-59;
Andrew S. Jacobs, Christ Circumcised: A Study in Early Christian History and
Difference (Philadelphia, PA: University of Pennsylvania Press, 2012). On the history
of circumcision, see David L. Gollaher, Circumcision: A History of the World’s Most
Controversial Surgery (New York: Basic, 2000).
85
Christ’s submission to the ritual, eight days after his birth, is mentioned briefly in
Luke 2:21. Following St. Paul’s insistence that Christians required only ‘spiritual’
circumcision, through the removal of sinful behaviour, early Church theologians
concurred that Christ’s circumcision was a volitional act by the infant Christ, which
instigated his Passion. See Leo Steinberg, The Sexuality of Christ in Renaissance Art
and in Modern Oblivion, 2nd edn. (Chicago: Pantheon, 1996), pp.51-4.
170
theological insistence that Christ submitted himself volitionally to the circumcision
suggests another reason for the medical context of some of its representations. In this
sense, Christ, although an infant, is seen to assume the gesture of the exemplary patient;
if medical patients are like Christ, by dint of their submission to surgical cutting, then
representing Christ as a model patient, in the single biblical scene where he undergoes a
surgical-like procedure, would affirm this association.
The Christ child embodies the virtues of the patient through his willingness to
undergo the procedure. The Gilte Legende emphasises the theological orthodoxy that
Christ’s participation in his circumcision was for the purpose of affirming the truth of
his incarnation: ‘He wost well that many wolde saie that he hadde not take a verray
bodi but a fantastik bodi, wherfor he wolde be circumcised for to destroie that errour
and shedde oute his blode’.86 The event is understood through its implementation of an
incarnational semiotics and, in this way, Christ is cast as a quintessential gestural
patient, undergoing suffering for its interpretive and semantic value. The reference, in
the Gilte Legende, to Christ’s naming ceremony, occurring simultaneously with
circumcision, compounds the performative emphasis. It quotes St. Augustine of Hippo:
‘“Cristen is a name of verrey rightwisnesse, of bounte, of purete, of pacience, of
clennesse, of humanite”’.87 Jesus, on the other hand, signifies medicine, as the author
(this time quoting St. Bernard) outlines: ‘“yt appesith the bolnyng of pride, he helithe
the woundes of enuye, he restreyneth the fere of lecherie, […] and chasith oute all filthe
and wrechidnesse”’.88 Christ’s ministry, comprising his dual role of human sufferer and
86
Jacobus de Voragine, ‘Circumcision’, in GL, Vol. I, p.79.
87
Jacobus de Voragine, ‘Circumcision’, p.77.
88
Jacobus de Voragine, ‘Circumcision’, p.78.
171
divine healer, is instigated in this ceremony; as a willing patient, he exemplifies the
transformation from physical pain to spiritual perfection.
This metamorphosis is made clear in affective accounts of the circumcision such
as that in The Life of our Lady by the Benedictine English monk and poet, John Lydgate
(c.1370-c.1450)
And withe a knyfe made full sharpe of stone,
His mothir lokyng with a pytous eye,
The childe was corve ther-with all, a-non,
That all a-boute the rede blode gan gon
Withoute a boode, as saythe Bonaventure,
That for the payne that he dyd endure,
And for sharpnes of the soden smerte,
The childe gan wepe þat pyte was to here.
Wherfore his mothir, of verrey tendre herte,
Oute brast on teres and myght her-self not stere,
That all bydewede were her eyne clere,
Whan she sawe hym that she louede soo,
So yonge, so fayre, wepyng so for woo (IV, 30-42).89
Lydgate foregrounds the pain and suffering wrought by the circumcision through a
focus on the knife, made of sharp stone, and its effect on Christ’s body: it ‘corve therwith all, a-non,/ That all a-boute the rede blode gan gon’. The ‘sharpnes of the soden
smerte’ causes Christ to weep, which in turn, triggers the Virgin’s spontaneous tears.
The focus on pain and physical injury, as well as the insistence upon the Virgin’s
emotional pain, prefigures the Passion. The empathy between the Virgin and Christ
shows again how the patient is constituted through being observed; the spectacle of
89
John Lydgate, A Critical Edition of John Lydgate’s Life of Our Lady, ed. by Joseph
A. Lauritis (Pittsburg: Duquesne University, 1961). Book and line numbers are cited in
the main text.
172
Christ’s involuntary weeping instigates Mary’s maternal identification, and this
response engages with the reader’s own affective recognition of this symbiotic
exchange. Such performances echo the way that the pose of the recumbent, lovesick
knight elicits pity from his beloved; they affirm the centrality of such gestures in
representations of the patient. The poem goes on, conveying Christ’s response to
Mary’s weeping:
[He] put his hande vnto hir visage,
On mouthe and eyne, passyngly benyngne,
And as he couthe goodly made a signe
Withoutyn speche, to stynt her wepyng (IV, 47-50).
The affective circuit is completed with Christ’s tactile and non-verbal implorations to
Mary to cease crying. The transition from the physical pain and bleeding of the
circumcision to emotional identification, and its role in inspiring the reader’s devotional
sensibilities, is emblematic of the deployment of the patient-figure in late medieval
culture, hesitating between suffering and transcendence. The blending of affect and
theological truth in accounts of the circumcision show how Christ, as exemplary patient,
performs suffering to assert orthodoxy and engender pietistic empathy and desire.
In accounts of the circumcision, Christ is promoted as the model of the fortitude,
transformation and performativity encompassed by the figure of the patient in Middle
English culture. Descriptions of the ideal patient in medical treatises not only appeal to
Christian virtues, they also participate in accounts and representations of suffering
across various types of literature and art. The emphasis on gestures and postures
attending such descriptions shows how the patient is not to be seen as someone who
simply experiences illness or disease and, in seeking health, submits to the auspices of
the practitioner; the patient’s subjectivity is mediated through cultural expectations and
173
understandings. For medieval authors, the capacious range of applicability of ‘the
patient’ offered a model of suffering which could assimilate medical, mystical and
chivalric gestures. The patient is therefore not a universal, natural entity but one who is
enunciated and inscribed through specific discursive modes where she assumes multiple
forms, serving various purposes.
174
Fig.9: English Altarpiece. Fragment of the Nativity in Alabaster. 1350-1400. London,
Victoria and Albert Museum, © Victoria and Albert Museum.
Fig.10: Nativity Scene. The Taymouth Hours. 1325-1350. London, BL Yates
Thompson MS 13, f.89.
175
Fig.11: English altarpiece. Fragment of the Circumcision of Christ in Alabaster. 14001500. London, Victoria and Albert Museum, © Victoria and Albert Museum.
176
CHAPTER THREE
Remedial Spaces and Institutional Language
The incorporation of performance and gesture attending conceptions of the patient in
late medieval England necessarily calls up questions of space. Whilst I have noted the
way that the bed, with its attendant images of recumbence and passivity, is intrinsic to
the idea of the patient, in this chapter I turn to the significance of the larger, institutional
spaces through which sick people are represented.1 As with the term ‘the patient’,
depictions of remedial spaces (such as hospitals or infirmaries) and their subjects in
such writings are not value-free or neutral; they are instead heavily invested with fears
of (moral as well as physical) contagion, hierarchical ideas of charitable restitution and
soteriological discourse. These spaces work, in such textual enunciations, as potent
vehicles for the assertion of moral and political investments attending the institutional
arrangements and the accommodation of sick and diseased bodies.
This analysis of healing spaces is underpinned by a perspective, formulated by the
French philosopher, Henri Lefebvre, that space is not absolute or geometrical but rather
culturally produced; in other words, whilst we may conceive of space as abstract and
1
Although ‘institution’, referring to an establishment, organisation or company (often
executing a public service), is a term that came into use only in the eighteenth century, I
employ it here to denote spaces characterised by the presence of regulated subjects,
(often) communal arrangements and under the control of the Church, a guild, the
sovereign or another power. See ‘institution, n.’ (7a), OED
http://www.oed.com.ezproxy.lib.bbk.ac.uk/view/Entry/97110?redirectedFrom=institutio
n [accessed 12 November 2014].
177
dimensional, our interactions and practices with (or within) space, as well as the
significations we accord it, are historically and culturally contingent.2 This insight opens
up a number of perspectives through which space can be analysed. Lefebvre outlines a
conceptual triad through which to formulate such an analysis: this encompasses the
relations which coalesce to ‘produce’ space and its order, the social practices of space
and the artistic or symbolic representational components.3 It is the latter feature,
emphasising the way that space is imagined and textually constructed, that I am
concerned with in this chapter. I argue that the sacred spaces of the infirmary and
2
Henri Lefebvre, The Production of Space, trans. by Donald Nicholson-Smith (Oxford:
Blackwell, 1991), pp.229-41. On Lefebvre’s distinction between concrete and abstract
space, see Stuart Elden, Understanding Henri Lefebvre: Theory and the Possible
(London and New York: Continuum Books, 2006), pp.188-90. Lefebvre’s work
continues to exert a considerable influence on scholarship concerned with space and its
meanings. For relevant studies by medieval scholars, see Barbara Hanawalt and Michal
Kobialka, eds., Medieval Practices of Space (Minneapolis and London: University of
Minneapolis Press, 2000); Meredith Cohen and Fanny Madeline, eds., Space in the
Medieval West: Spaces, Territories and Imagined Geographies (Farnham, Surrey and
Burlington, VT: Ashgate Publishing, 2014); Ruth Evans, ‘The Production of Space in
Chaucer’s London’, in Chaucer and the City, ed. by Ardis Butterfield (Cambridge: D.S.
Brewer, 2006), pp.41-56; Robert Rousse, ‘Walking (between) the Lines: Romance as
Itinerary/ Map’, in Medieval Romance, Medieval Contexts, ed. by Michael Staveley and
Rhiannon Purdie (Cambridge: D.S. Brewer, 2011), pp.135-48; Peter Brown, Chaucer
and the Making of Optical Space (Bern: Peter Lang Ltd., 2007), pp.23-40.
3
Lefebvre names these, respectively, representations of space, spatial practice and
representational spaces. See Lefebvre, Production of Space, p.8.
178
hospital, outlined in documents such as monastic customaries and rules, incorporate
medical learning and language to sustain their articulations of physical and spiritual
healing. In this way, medicine is implicated in the assertion of normative moral
behaviour as well as bodily regulation. However, the restoration of physical and
spiritual wellbeing necessarily calls up ideas of deviation, and I explore the way that
instructional texts designate the sick subject in terms of aberrance and alterity. Finally, I
analyse the way that this model of illness translates into two other institutional spaces,
the prison and purgatory. My interest is not in proffering a theory of how such accounts
reflected actual spatial practices and management; it is instead to elucidate the ways in
which they imagine such spaces through Christian ideas of punishment, salvation and
healing. Central to this analysis is the extent to which medical language and knowledge
is incorporated into the religious outline of healing spaces.
The incorporation of rational medical knowledge in late medieval didactic and
authoritative texts outlining institutional organisation and practices is one example of
what some have seen as the ‘medicalisation’ of that culture. Michael McVaugh defines
this process as happening ‘when aspects of human behaviour that had previously been
judged normal or deviant, good or bad, by the lay public are assigned to medical control
and are redefined as health and illness, shedding their moral overtones’.4 However, the
assumption that medical knowledge or practice floats free of moral concerns and evades
participation in the sanctioning of culturally normative behaviours is one that I contest
in this chapter. Certainly, many working in the medical humanities show how the
‘medicalisation’ of contemporary life, evinced through the increase of features like
pharmaceutical behavioural medicines, gastro-bands and public discussion of conditions
4
McVaugh, Medicine before the Plague, p.190.
179
such as foetal alcohol syndrome, is wholly bound up with the implementation of ethical
norms.5 Similarly, the institutional language considered here frames discourses of
disgust, alterity and spiritual liberation through a medical register. Late medieval
English culture can therefore be understood as a medicalised one from the perspective
of this discursive embedding of rational medicine within institutional language.
The Sacred Space of the Hospital
The organisation and layout of hospitals in the Middle Ages was largely based on the
systems put in place by late antique monastic communities for the care of those who
were ill, injured, incapacitated and elderly. The precept enshrined in the sixth-century
Rule of St. Benedict, concerning the abbot’s responsibility of ensuring that the sick are
cared for, stipulates that a space should be set aside for convalescence within the
monastic precinct.6 Due to the renunciation of worldly comforts intrinsic to the
monastic life, some Church authorities condemned the availability of medical care for
5
In contrast to McVaugh, Peter Conrad offers a definition of medicalisation devoid of a
moral distinction: ‘“Medicalization” describes a process by which nonmedical problems
become defined and treated as medical problems, usually in terms of illness and
disorders’. See Conrad, Medicalization on Society, p.4. However, as I argue in relation
to medieval medicine, the boundaries between what is considered as ‘medical’ and
‘nonmedical’ have always been porous.
6
See Rule of Saint Benedict, p.91, and Cannon, ‘Monastic Productions’, p.316. This
edict is repeated in the tenth-century document of the English Benedictine reform, the
Regularis Concordia. See Nicholas Orme and Margaret Webster, The English Hospital
1070-1570 (New Haven and London: Yale University Press, 1995), pp.17-18.
180
monastics;7 but over the course of the medieval period, as infirmaries became an
inherent feature in the architecture of monasteries and many monks studied and
practiced medicine and surgery, such care came to be widely accepted.8 Monasteries
became known ‘for their role in preserving and disseminating medical knowledge,
particularly in the centuries prior to the rise of universities and the religious reforms that
took hold in the twelfth century’.9 Whilst the Fourth Lateran Council prevented those in
higher orders from performing surgery (at least officially), this resulted not in the
cessation of such procedures but in monasteries employing lay practitioners or clerics in
minor orders to perform them.10 For instance, qualified physicians were in service at
two Norfolk monasteries, St. Benet’s at Holme and Norwich cathedral priory;
furthermore, the many references to herbal medicine, surgery and phlebotomy in the late
medieval customaries of English monastic houses attest to the variety, and widespread
nature, of medical and surgical healing in such environments.11 In fact, because
7
Bernard of Clairvaux, for example, condemned the consumption of medicines and
consultation of medical practitioners by monks as inconsistent with the austere lifestyle
of the Cistercian order. See Christopher Holdsworth, ‘Bernard as a Father Abbot’, in A
Companion to Bernard of Clairvaux, ed. by Brian Patrick McGuire (Leiden: Brill,
2011), pp.169-219 (p.210).
8
See Miri Rubin, Charity and Community in Medieval Cambridge (Cambridge and
New York: Cambridge University Press, 1987), pp.149-51, and Carole Rawcliffe, ‘Care
for the Sick’, pp.41-6.
9
Yearl, ‘Medieval Monastic Customaries’, p.179.
10
Rawcliffe, ‘Care for the Sick’, pp.46-7. See also Amundsen, Medicine, Society and
Faith, pp.235-9.
11
Rawcliffe, ‘Care for the Sick’, pp.47-8.
181
infirmaries tended to be multifunctional spaces, housing the sick and old as well as
those who were convalescing following phlebotomy, they would have been much
frequented by monastics.12 The importance of these spaces is suggested in the way that
some, such as the one at Fountains monastery in Yorkshire, were ‘large, richly
decorated and imposing’.13
The infirmary and general monastic modus vivendi provided the template for the
hospital.14 Following the first Norman free-standing hospital in the eleventh century,
such institutions began to proliferate in England.15 They resembled monasteries
(although distinct from monasteries themselves) through their inclusion of communal
prayer, liturgical participation and submission to a rule.16 Many institutions favoured the
12
Yearl, ‘Medieval Monastic Customaries’, p.177.
13
Rawcliffe, ‘Care for the Sick’, p.49.
14
Crislip, From Monastery to Hospital, pp. 9 and 100-1.
15
See Orme and Webster, The English Hospital, pp.20-3. See also Kealey, Medieval
Medicus, p.89. For proliferation of hospitals in England, see James W.Brodman,
‘Hospitals in the Middle Ages’, in A Companion to the Medieval World, ed. by Carol
Lansing and Edward D. English (Chichester, Malden and Oxford: Wiley-Blackwell,
2005), p.257.
16
See Rubin, Charity and Community, p.159; Rawcliffe, Medicine and Society, p.20;
Sethina Watson, ‘The Origins of the English Hospital’, Transactions of the Royal
Historical Society, 6:16 (2006), 75–94. On the wider development of hospitals see
Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (Cambridge
and New York: University of Cambridge Press, 1999); Yasser Tabbaa, ‘The Functional
Aspects of Medieval Islamic Hospitals’, in Poverty and Charity in Middle Eastern
182
Augustinian rule, which reached England from Italy in the eleventh century, because it
‘encouraged its followers to follow a regular round of worship and self-discipline while
allowing them flexibility to do tasks in the outside world. It was thus particularly
appropriate for clergy running hospitals’.17 Typically, hospital carers would be subject
to the rule; patients were either free from this requirement or obligated to follow a less
rigorous version of it. This adherence to a religious framework privileged the spiritual
and salvational contexts within which efforts to heal the body were situated. Therefore a
chapel was usually a prominent part of the hospital precinct, and it was often annexed to
the infirmary.18 However, the religious orientation of English hospitals was also
informed by their charitable nature, being often founded by confraternities and parish
bodies, as well as more secular groups like professional guilds.19 In this sense, they can
Contexts, ed. by Michael Bonner, Mine Ener and Amy Singer (Albany, NY: State
University of New York Press, 2003), pp.95-120; Barbara Bowers, ed., The Medieval
Hospital and Medical Practice (Hampshire and Burlington, VT: Ashgate Publishing,
2007); John Henderson, The Renaissance Hospital: Healing the Body and Healing the
Soul (New Haven and London: Yale University Press, 2006).
17
Orme and Webster, The English Hospital, p.70. See also David Knowles and R.
Neville Hadcock, Medieval Religious Houses: England and Wales (London: Longman,
1953) p.251. For background on the Augustinian Rule as well as a summary of the
eleventh-century reform of monastic culture in England and Europe, see Cannon,
‘Monastic Productions’, pp.317-9.
18
Orme and Webster, The English Hospital, pp.35 and 87-8; Rubin, Charity and
Community, pp.1-10.
19
Sheila Sweetinburgh, The Role of the Hospital in Medieval England: Gift Giving and
the Spiritual Economy (Dublin: Four Courts Press, 2004), p.13; Miri Rubin,
183
be seen as zones of reciprocity where the provision of rest and care by wealthy patrons
could be repaid by the prayers recited for their souls by the inmates.20
The strongly religious characteristics of late medieval English hospitals have
informed debates amongst historians of the extent to which they can be understood as
‘medical’ spaces. Miri Rubin, in a study of the hospital of St. John the Evangelist in
Cambridge between the thirteenth and sixteenth centuries, notes the absence of practical
medical contact in its accounts. She concludes that ‘hospitals offered shelter, food,
spiritual comfort and a disciplined environment. Some contemporaries would have
considered these all that is needed for a man’s recuperation and regeneration’.21 Carole
Rawcliffe concurs, arguing that hospitals ‘were neither prepared nor equipped to
provide much in the way of specialist medical care’, and that no attempt was made in
England to make use of physicians or surgeons in hospitals.22 However, Patricia Cullum
challenges this consensus: having identified references to a ‘medica’, or physician,
named Ann in a 1276 ordinance of St. Leonard’s Hospital, York, Cullum concludes that
it is highly unlikely that hospital care did not include a good degree of medical
‘Development and Change in English Hospitals, 100-1500’, in The Hospital in History,
ed. by Lindsay Granshaw and Roy Porter (London and New York: Routledge, 1989),
pp.41-59 (p.48); Brodman, ‘Hospitals in the Middle Ages’, p.258.
20
The relationship of charity to the institutional subject is discussed below.
21
Miri Rubin, Charity and Community, p.153.
22
Carole Rawcliffe, Medicine and Society, p.210. There is a marked distinction between
English hospitals and others in western Europe where medical professionals such as
physicians and surgeons commonly appear in hospital sources. See Brodman, ‘Hospitals
in the Middle Ages’, p.265.
184
treatment.23 Furthermore, the references in late medieval English monastic customaries
and accounts of monastic visitations by ecclesiastical authorities include much reference
to specific medical care being made available for enclosed monastics that fall sick.24
In some respects, this debate is misleading as it inculcates an idea of the medieval
English hospital as a stable and homogenous space that either incorporated or eschewed
medical healing. Yet the medieval hospital should not be seen as ‘a unitary or clearly
bounded phenomenon’.25 The identification of a building or an institution as a hospital
could signify that it provided: food and shelter to travellers; lodgings to indigent
students, the poor, and pregnant women; care for the sick, the elderly, people with
various impairments, orphans, those who were mentally ill and lepers.26 The rise of
corrodians, or fee-paying inmates, from the ranks of the more well-to-do in the
23
P.H. Cullum, Cremetts and Corrodies: Care of the Poor and Sick at St. Leonard’s
Hospital, York, in the Middle Ages, Borthwick Paper, No.79 (York: University of York,
1991), pp.13-15.
24
See Carol Rawcliffe’s identification of physicians at Norfolk mentioned above. Also,
a physician is mentioned in the customary for the Augustinian priory at Barnwell in
Cambridgeshire. See The Observances in Use at the Augustinian Priory of Barnwell,
Cambridgeshire, ed. by John Willis Clark (Cambridge: Macmillan and Bowes, 1897),
p.203. For an argument that health care in the monastery provided the model for later
hospitals, see Crislip, From Monastery to Hospital, pp.100-1.
25
Peregrine Horden, ‘A Discipline of Relevance: The Historiography of the Later
Medieval Hospital’, Social History of Medicine, 1:3 (1988), 359-74 (p.366).
26
See Kealey, Medieval Medicus, p.82, and Orme and Webster, The English Hospital,
pp.40 and 119.
185
fourteenth century comprised yet another type of hospital inmate.27 Hospitals could also
range in size from large institutions, such as St. Leonard’s at York, to a host of small
houses, or maisons dieu, often run by the Church or a secular body under the authority
of its patrons.28 Furthermore, the function of any one hospital could be subject to
change over time: for example, St. Mary Bethlehem in London turned to the sale of
indulgences, or pardons, to boost finances following the Black Death.29 It is therefore
crucial, when analysing the way that such spaces were conceived of by medieval
people, to retain an awareness of the fluidity of such establishments and their
heterogeneous character. Faith Wallis argues that ‘whether a doctor was present or not,
and however they framed their mandate, medieval hospital staff cared for sick people in
accordance with mainstream learned traditions of medicine. They embedded this care,
however, in a comprehensive religious context’.30 Medieval hospitals, along with
monastic infirmaries were, by virtue of their structural organisation and the practices
27
See Sweetinburgh, Role of the Hospital, p.27, and Cullum, Cremetts and
Corrodories, pp.20-28.
28
By the fourteenth century, St. Leonard’s listed its retinue as comprising thirteen
chaplain bothers, eight sisters, a number of lay brothers and lay servants. See Cullum,
Cremetts and Corrodories, p.7. For description of maisons dieu, see Sweetinburgh, Role
of the Hospital, p.33. Sweetinburgh speculates that their emergence was a consequence
of the way that the bigger hospitals had been subject to mismanagement and corruption .
This may be seen in connection with proposals for reform of English hospitals put
forward in the fourteenth and fifteenth centuries. See Orme and Webster, The English
Hospital, pp.132-6.
29
Carole Rawcliffe, Medicine for the Soul, p.166.
30
Faith Wallis, ‘Introduction’, in Medieval Medicine, ed. by Faith Wallis, p.xx.
186
they engendered, sacred spaces; depending on the specific kind of hospital, medical
knowledge and practices could be incorporated within its religious framework.
The Textual Construction of the Institutional Subject
If healing spaces such as the hospital and monastic infirmary encompassed medical
practice within their structural and practical configurations, to what extent are the
concepts or representations of such spaces imbued with medical language? What part
does medicine play in the institutional imaginary? In confronting such questions, it is
important to acknowledge the ways in which the spatial ordering or management of
bodies invests them with particular forms of knowledge. The medical subject, as
understood today, is constructed through an understanding of internal physiology
corresponding with symptomatic as well as behavioural manifestations; the (real or
imagined) spaces she inhabits both determine and accommodate her subjectivity.
Michel Foucault’s analysis of the place of institutions in the operations of power is
relevant here for its insight into the way that such power is enacted through bodily
performance. In The Birth of the Clinic and Discipline and Punish, Foucault challenges
the ‘grand narratives’ of traditional historiography, and their teleological assumptions of
ineluctable progress or social evolution. In countering such narratives, he explores the
codes of knowledge or discursive modalities which delimit and determine thought,
concepts and practices in any particular field or time period.31 According to this
31
Foucault applies what he sees as an archaeological method to render visible such
codes. See Michel Foucault, Archaeology of Knowledge, trans. A.M. Sheridan Smith
(London and New York: Routledge, 1972, repr., 2003) pp.8-9 and 171-3. Foucault also
employs a methodology of ‘genealogies’ referring to how knowledge is comprised of a
187
analysis, power in the modern state works through diffusion and becomes instituted
through its incorporation within the docile, disciplined body; the body correspondingly
enacts a host of social controls through its everyday movements and gestures. 32 The
role of the institution is intrinsic to this incorporation as it provides a context, systems
of rules and spaces that make possible the performance of discipline and, in doing so,
appears benign rather than oppressive.33 Central to the role of the institution is the way
that the power structures in one field (such as medicine) are replicated in a host of
others (penal, education, the military), and the importance to this of the uses and
meanings invested in spaces.
In Discipline and Punish, Foucault traces the development of systems of social
control and punishment from the overt violence of their early modern manifestations to
their technological, observational and highly regulated modern forms. He contrasts the
rational and sophisticated discourses of modern power with a blunt and wholly punitive
‘series of inheritances’, which arise from contingent ruptures or dislocations in
historical continuities. See Charles E. Scott, ‘The Power of Medicine, The Power of
Ethics’, The Journal of Medicine and Philosophy, 12 (1987), 335-50 (p.339).
32
The much referenced Panopticon, the nineteenth-century circular prison proposed by
Jeremy Bentham (1748-1832), is the model par excellence advanced by Foucault to
outline the role of the body and surveillance in social control. See Foucault, Discipline
and Punish: The Birth of the Prison, trans. and ed. by A.M. Sheridan Smith (London
and New York: Routledge, 1977, repr., 1991), pp.195-230.
33
See Colin Jones and Roy Porter, ‘Introduction’, in Reassessing Foucault: Power,
Medicine and the Body, ed. by Colin Jones and Roy Porter (London and New York:
Routledge, 1994), pp.1-16 (p.11).
188
premodern one.34 This dichotomy is questionable for the way it ‘casts the Middle Ages
in the role of modernity’s all-purpose ‘other’, a place where the carceral society did not
yet exist, a prelapsarian world still to be infected by the concept of the modern
subject’.35 The engagement with representations of healing spaces in this chapter
informs my claim that what we recognise today as modern ‘medical subjects’ have their
analogues in late medieval texts, allowing for the fact that they are not understood as
medical subjects per se, or that they are constituted in terms of a set of very different
discourses.
34
Foucault condenses this opposition in his descriptions of the execution of Robert-
François Damiens (1715-57), for his attempted regicide of France’s King Louis XV
(1710-74), and the 1837 penal codes drawn up by French politican Léon Faucher (180354). See Foucault, Discipline and Punish, pp.3-7.
35
Andrew James Johnston, ‘The Secret of the Sacred: Confession and the Self in Sir
Gawain and the Green Knight’, in Performances of the Sacred in Late Medieval and
Early Modern England, ed. by Susanne Rupp and Tobias Döring (Amsterdam and New
York: Rodopi, 2005), pp.45-63 (p.55). Other discussions of Foucault’s ‘medievalisms’
include Carolyn Dinshaw, Getting Medieval: Sexualities and Communities, Pre- and
Postmodern (Durham NC: Duke University Press, 1999) pp.196-205; Kathleen Biddick,
The Typological Imaginary: Circumcision, Technology, History (Philadelphia:
University of Pennsylvania Press, 2003); Robert Mills, Suspended Animation: Pain,
Pleasure and Punishment in Medieval Culture (London: Reaktion, 2005), pp.13-14;
Louise Fradenburg and Carla Feccero, ‘Introduction: Caxton, Foucault and the
Pleasures of History’, in Premodern Sexualities, ed. by Louise Fradenburg and Carla
Feccero (New York: Routledge, 1996), pp.xii-xxiv.
189
Such subjects are invested with codes of knowledge that demarcate the experience
of sickness and healing in terms of the Christian economy of sin and salvation. These
investments are not revealed through consideration of the extent to which hospital or
infirmary inmates might have experienced, accepted or practiced this subjectivity; they
are decipherable through linguistic and rhetorical analysis and through identification of
the textual construction of the subject in institutional discourse.36 The advantage of this
approach is that it resists speculation on the ‘real’ effects of, for example, edicts in a
monastic customary on the quotidian life of the infirmary. Instead, it focuses on the
tangibility and materiality of the language itself and conceives of the medical subject as
one created and delimited by authoritative and determinative languages, mediating its
experiences and structuring the spaces it inhabits. Key to the efficacy of such language
is the way in which a medically instituted knowledge of the body serves to circumscribe
or exclude the subject. Foucault refers to this as a ‘distribution of illness’, which
includes:
All the gestures by which, in a given society, a disease is circumscribed,
medically invested, isolated, divided up into closed, privileged regions, or
distributed throughout cure centres, arranged in the most favourable way […]. It
brings into play a system of options that reveals the way in which a group, in
36
Foucault’s idea of power is in opposition to the Marxist conception of it as a macro-
structure; he conceives of power ‘as a relationship which was localised, dispersed,
diffused […] operating at a micro, local and overt level through sets of specific
practices’. See Bryan S.Tuner, ‘From Governmentality to Risk: Some Reflections on
Foucault’s Contribution to Medical Sociology’, in Foucault: Health and Medicine, ed.
by Alan Petersen and Robin Bunton (Lonon and New York, 1997), pp.ix-xii.
190
order to protect itself, practices exclusions, establishes the forms of assistance,
and reacts to poverty and to the fear of death.37
Medicine can thus comprise a vehicle through which a culture might protect its own
homogeneity and isolate or marginalise elements that are perceived to be foreign or
dangerous to it. Certainly, the shifting ground between disease and sin in the Middle
Ages could work to exclude or confine the ‘sick’ – a category which could, depending
on its employment in particular contexts, encompass various marginalised people or
groups. The ordering of space is fundamental to the effort to circumscribe, and this can
explain the type of prescriptive language that constellates around the space of the
infirmary in monastic documents, analysed below, particularly in their concern with
morality, behaviour and the necessity of surveillance.38
Bare-life Charity
An adoption of the Foucauldian idea of the exclusion or marginalisation of the sick,
characterising the construction of the medical subject, needs to be probed in relation to
the insistence on Christian charity accompanying many late medieval articulations of
the provision of care for the sick. A fourteenth-century Middle English translation of the
Rule of St. Benedict exemplifies the Christological basis for providing such care:
37
Foucault, Clinic, p.17. In Birth of the Clinic, Foucault is mostly concerned with what
he sees as the structural discontinuities or ruptures that bring about the rise of clinical
medicine in the eighteenth century. See especially, pp.ix-xix.
38
For Foucault’s treatment of medical space, see Chris Philo, ‘The Birth of the Clinic:
An Unknown Work of Medical Geography’, Area, 32:1 (2000), 11-19 (p.17).
191
Of þe seke spekis sain benet in þis sentence, And cumandis ouir al þing þat man
sal ta yeme of þaim, þat tay be serued als it ware god him-selfe. For he sal say on
domis-day: “I was seke, ye visit; þat ye did til an of myne, ye did it me” (25-9).39
The responsibility of the abbot and the monastic community as a whole to care for the
sick is linked to Christ’s words, identifying with the sick and poor in Matthew’s
gospel.40 The Rule thus makes clear that caring for ill patients equates to caring for
Christ himself and, as such, is linked to one’s fate on judgement day. Benedict expands
on the imperative to care for the sick: ‘A hus sal þai haue bi þam ane. And tat so þat sal
serue þam dute gode, and do hir miht for to serue þam wel and wid luue’ (35-7). The
care that is to be given to the sick within the monastic environment is advanced by the
allocation of a space – ‘a hus’ – where they can be cared for. The infirmary, comprising
this space, is thus invested with the qualities of servitude and love, or caritas. As it is
rendered in the Benedictine Rule, it enables the bestowal of dedicated and affective care
upon the sick and infirm.
The infirmary as a place of compassion also finds expression in monastic
customaries from the high and later Middle Ages.41 Such documents were produced
39
‘Northern Prose Version’, in Three Middle-English Versions of the Rule of St. Benet
and Two Contemporary Rituals for the Ordination of Nuns, ed. by Ernst A. Kock, EETS
o.s. no.120 (London: Published for the Early English Text Society by Kegan Paul,
Trench, Trübner and Co., 1902), p.26. Citations are by line number in the text.
40
DR, Matt.25:36-40.
41
Customaries qualified and adapted the rule of the order governing the monastery
(such as the Benedictine one) in ways specific to the local circumstances and
environment of a particular monastery. They tended to provide much more specific
192
either upon foundation of a monastic house or to regularise customs (or enact reforms)
in an existing one. They were retained (and revised) for use by subsequent
generations.42 The twelfth-century customary of the Augustinian monastery of St. Giles
at Barnwell, Cambridgeshire lists the qualities that should apply to the master of the
infirmary:
The Infirmarer therefore, who should have the care of the sick, ought to be a
gentle, pleasant and obliging man, compassionate to the sick and willing to
condescend to appease their needs affectionately. It should rarely or never happen
that he has not, in his store, ginger root, cinnamon, peony, and such like, so as to
be able to render prompt support to the sick if struck by disease […] He is to
prepare their food at the right time, show their urine to the physician, and he haves
responsibility for paying careful attention to their eating and drinking […] The
detail to the running of the monastery than the rule allowed for. Their usefulness as a
historical source has been challenged by some scholars ‘expressing concern that the
contents of customaries represented the normative ideals of monastic legislators rather
than the lived experiences of individual monks’. See Scott G. Bruce, Silence and Sign
Language in Medieval Monasticism: The Cluniac Tradition, c.900-1200 (Cambridge
and New York: Cambridge University Press, 2007), p.7. However, they are exemplars
of the ideological ways in which these authorities envisioned monastic spaces, such as
the infirmary. For debates on the usefulness of customaries as historical sources, see the
collection of essays in Susan Boynton and Isabelle Cochelin, eds., From Dead of Night
to End of Day: The Medieval Customs of Cluny (Turnhout: Brepols, 2005),
42
See Julie Kerr, Monastic Hospitality: The Benedictines in England, c.1070-c.1250
(Woodbridge: Boydell Press, 2007), pp.13-15.
193
Infirmarer should have Mass celebrated daily for the sick either by himself or
another. 43
The infirmary is here constituted as a place that brings together concerns of the body
(food, urine, medicine) and spiritual devotion; it also achieves this spatially by bringing
together the place of worship with that of liturgical devotion. In doing so, it qualifies the
Christian imperative to care for the sick by listing the indulgent, patient and affectionate
care which the infirmarer is to lavish upon the the inhabitants.
Although the Barnwell customary delineates its infirmary inmates in privileged
terms, the inculcation of perspectives of the poor as indices of Christ can be seen to
enact its own circumscription. This is clearly evinced in narratives that focus on
superlative instances of charity. A hierarchal relationship between those who offer care
and those who receive it is evoked in the vita of a highly popular and venerated saint
across late medieval Europe, Elizabeth of Hungary (1207-31).44 Elizabeth was the
43
The Observances in Use at the Augustinian Priory of Barnwell, Cambridgeshire, ed.
by John Willis Clark (Cambridge: Macmillan and Bowes, 1897), pp.202-5 (my
translation from the Latin is based on Clark’s). For a general history of St. Giles’s
monastery at Barnwell, see L.F. Salzman, ed., A History of the County of Cambridge
and the Isle of Ely: Victoria County History, Vol. II (London: Published for the
University of London Institute of Historical Research by Oxford University Press,
1948), pp.234-49.
44
On the spread of Elizabeth’s cult in Europe, see Dávid Falvay, ‘St. Elizabeth of
Hungary in Italian Vernacular Literature: Vitae, Miracles, Revelations, and the
Meditations on the Life of Christ’, in Promoting the Saints: Cults and their Contexts
from Late Antiquity until the Early Modern Period: Essays in Honour of Gábor
194
daughter of Andrew, King of Hungary and was revered for her establishment of
charitable institutions including a hospital.45 Her biography, included in the Legenda
Aurea (and its Middle English translation, the Gilte Legende), describes her personally
tending to the sick in opposition to the wishes of her family.46 Late medieval stories and
images depicting her helping the poor and sick, particularly lepers, are legion.47
Klaniczay for his Sixtieth Birthday, ed. by Ottó Gecser, József Laszlovsky, Balázs
Nagy, Marcell Sebők and Katalin Szende (Budapest: Central European Press, 2011),
pp.137-50, and Ottó Gescer, ‘Lives of St. Elizabeth: Their Rewritings and Diffusion in
the Thirteenth Century’, Analecta Bollandiana, 127:1 (2009), 49-107.
45
The main source of Elizabeth’s life comes from the miracle depositions made by her
companions and servants before a papal commission at her canonization hearings in
1235. For an account and translation of these, see Kenneth Baxter Wolf, The Life and
Afterlife of Elizabeth of Hungary: Testimony from her Canonization Hearings (Oxford
and New York: Oxford University Press, 2010).
46
On identification with the sick and poor and the rejection of familial expectations as
constitutive elements in late medieval female piety, see Michael E. Goodich, ‘The
Contours of Female Piety in later Medieval Hagiography’, Church History, 50:1 (1981),
20-32.
47
For some examples of the circulation of depictions of Elizabeth, see David Griffith,
‘The Reception of Continental Women Mystics in Fifteenth- and Sixteenth-century
England: Some Artistic Evidence’, in The Medieval Mystical Tradition in England:
Exeter Symposium VII: Papers Read at Charney Manor, July 2004, ed. by E.A. Jones
(Cambridge: D.S. Brewer, 2004), pp.94-117; Erno Nemes-Kovacs, ‘The Newly
Discovered Reliquary Sculpture of Saint Elizabeth of Hungary’, Franciscana 8 (2007),
107-117.
195
Elizabeth’s exemplary sanctity is advanced in her vita in the Gilte Legende. Following
her early widowhood, she gives her riches to the poor and devotes herself to the care of
the sick in the hospital she has founded:
She made a gret hous under the castell wherinne she might resseyue and norisshe
gret multitude of pore folke, and eueri day she visited hem, sparing for no
corrupcion of euel eyre, ne for no manere of foule siknesse, but wasshed hem and
wiped hem with her owne hondes.48
Elizabeth’s selfless commitment, exemplified through her tactile serving of the inmates
whilst risking contagion, gathers impetus from the contrast between her high social
standing and the poor people she serves. This is rendered in structural terms by her
creation of the ‘gret hous’ under her castle. In pietistic terms, the more defined this
contrast is between the rich holy woman and her sick guests, the more saintly she
appears:
She was of so gret humilite that for the loue of God she leyde in her lappe a sike
man with horrible uisage and stinkinge hede, and she wysshe his uisage and his
hede and clipped of the filthe from his hede, wherfor her women lough her to
scorne.49
Elizabeth’s self-abasement takes place through her performance of charity.50 The
ridicule she receives from her own serving women for conferring care, through laying
48
Jacobus de Voragine, ‘Elizabeth of Hungary’, in GL, Vol. II, p.846.
49
Jacobus de Voragine, ‘Elizabeth of Hungary’, p.844.
50
The motif of the saint’s self-abasement was one that was deployed widely in late-
medieval hagiographies, in line with that culture’s emphasis on asceticism and piety.
This often took the form of the saint tending to the sores of lepers or kissing them (a
topic explored more fully in the next chapter of this thesis). For a number of examples,
196
the sick man on her lap and removing his dirt with her hands further emphasizes her
humility.
The same indexical function that is at work in the Benedictine Rule and the
Barnwell Observances is affirmed here through the correspondence of the sick man
with Christ. This includes the inversion whereby the saint’s humility makes her equally
like Christ; although Elizabeth’s maternal care also evokes the image of the Virgin
Mary holding (both the infant and deposed) Christ, and this image is explicitly evoked
later: ‘bi the ensaumple of the Uirgine Marie she wolde bere her sone in her armes’.51
However, the narrator’s Christ-like elevation of the patient is attended by the fascination
with his obscenity: his ‘horrible uisage and stinkinge hede’ again sets up an opposition
between the saint’s spiritual purity and the visceral materiality through which it
see Catherine Peyroux, ‘The Leper’s Kiss’, in Monks and Nuns, Saints and Outcasts:
Religion in Medieval Society, ed. by Sharon Farmer and Barbara H. Rosenwein (Ithaca,
NY: Cornell University Press, 2000), pp.172-88. Dyan Elliot has identified a precursor
to late medieval accounts of saintly self-abasement in the form of Radegunde (c.520c.587), the Thuringian princess and founder of the abbey of the Holy Cross at Poitier,
who would secretly rise at night in her convent and perform menial tasks such as
cleaning her fellow nuns’ shoes and scrubbing the toilets. See Elliot, The Bride of Christ
goes to Hell: Metaphor and Embodiment in the Lives of Pious Women, 200-1500
(Philadelphia: University of Pennsylvania Press, 2012), pp.98-99.
51
Jacobus de Voragine, ‘Elizabeth of Hungary’, p.844. See also Anja Petrakopoulos,
‘Sanctity and Motherhood: Elizabeth of Thuringia’, in Sanctity and Motherhood: Essays
on Holy Motherhood in the Middle Ages, ed. by Anneke B. Mulder-Bakker (New York:
Garland, 1996), pp.259-96.
197
expresses itself, as Elizabeth nonchalantly performs the corporal works of mercy.52
Again, we see her repeating her acts of humility as she bears the ‘sike bodies to her
priuies for to ese hem and bere hem ayen to her beddis’ and wipes the wounds of
lepers.53 The bodies of the sick – their weakness, filth, incontinence and wounds –
become ciphers of the saint’s charity and humble endurance. Her tactile attentions and
labour manifests her humble, self-effacing integrity in contrast to the weeping and
incontinent bodies of those she cares for.
Yet this account of Elizabeth’s servitude employs a register of disgust and
aversion as opposed to a specifically medical one. The narrator is less interested in
whether Elizabeth’s charges make a return to health but rather in how her engagement
with their weak and weeping bodies signals her sanctity. In this sense, her patients can
be thought to resemble the privileged and abject role of the homo sacer, the distinctive
figure of Roman society who is unprotected by law and who therefore may be killed
with impunity and without sacrificial merit. Giorgio Agamben’s exposition of the trans-
52
On late medieval acclamations of Elizabeth’s works of mercy, see Ivan Great, ‘Dei
Saturitas: St. Elizabeth’s Works of Mercy in the Medieval Pictorial Narrative’, in
Insights and Interpretations: Studies in the Celebration of the Eighty-Fifth Anniversary
of the Index of Christian Art, ed. by Colum Hourihane (Princeton, NJ: Princeton
University Press, 2002), pp.168-81. For an explication of the seven corporal and
spiritual works of mercy, see Suzanne Roberts, ‘Contexts of Charity in the Middle
Ages: Religious, Social, and Civic’, in Giving: Western Ideas of Philanthropy, ed. by
Jerome B. Schneewind (Bloomington and Indianapolis: Indiana University Press, 1996),
pp.24-53 (esp. pp.27-8).
53
Jacobus de Vorgaine, ‘Elizabeth of Hungary’, p.851.
198
historical manifestations of this figure configures it as existing outside the political
realm, inhabiting a ‘bare life’ existence, whilst simultaneously underpinning the
constitution of political sovereignty.54 The bare life of Elizabeth’s patients is suggested
in the way that their wounded and festering bodies distinguish them as Christ-like,
whilst their existence accumulates meaning only through the performance of charity by
their noble patron . Their presence is exclusively oriented to their ability to generate the
sanctity of their carer.
This dynamic is also apparent in a mid-fifteenth-century stained glass image of
Elizabeth, forming part of the great east window in the church of St. Peter Mancroft in
54
Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life, trans. by Daniel
Heller-Roazen (Stanford, CA: Stanford University Press, 1998). Whilst Agamben does
not expansively detail the place of the homo sacer in medieval culture, he does suggest
that the titular werewolf in Marie de France’s (fl.1170-1200) Bisclavret resembles one.
See Agamben, Homo Sacer, p.104. A number of medievalists have made use of
Agamben’s theory: Robert Mills, ‘Havelok’s Bare Life and the Significance of Skin’, in
Reading Skin, ed. by Katie L. Walter, pp.57-80; James Wade, Fairies in Medieval
Romance (New York and Basingstoke: Palgrave Macmillan, 2011), pp.73-108; Ruth
Evans, ‘Sir Orfeo and Bare Life’, in Medieval Cultural Studies: Essays in Honour of
Stephen Knight, ed. by Ruth Evans, Helen Fulton and David Matthews (Cardiff:
University of Wales Press, 2006), pp.198-212; Robert S. Sturges, ‘The State of
Exception and Sovereign Masculinity in Troilus and Criseyde’, in Men and
Masculinities in Chaucer’s Troilus and Criseyde, ed. by Tison Pugh and Marcia Smith
Marzec (Woodbridge: D.S. Brewer, 2008), pp.28-42.
199
Norwich.55 It depicts the saint, dressed in virginal blue, handing out alms to the poor
(fig.12). Elizabeth, at the centre of the image is watched by her father, Andrew II of
Hungary, embedded within the enclave of his castle, and looking on grim-faced as
Elizabeth doles out her gifts to the sick and poor. The multitude of poor converging on
Elizabeth forms an enclosure about her that contrasts with the building that protects her
father. The image thus signifies Elizabeth’s rejection of worldly riches and status (she
stands with her back to the castle) and her commitment to merciful piety. However,
Elizabeth is also defined in contrast to the suppliants. Whilst she is the only full-length
figure in the image, the beggars are represented metonymically by their deformed faces,
half-concealed by their cloaks (possibly to represent the risk of contagion) and their
outstretched palms as they compete with each other for the gifts of the saint. Similar to
the Gilte Legende account, they are drawn as partially faceless and passive beings; they
55
This window, along with the inclusion of Elizabeth’s vita in the Gilte Legende and
Osbern Bokenham’s (c.1393-c.1463) hagiographical collection, attests to Elizabeth’s
popularity in England. Margery Kempe makes reference to the writings of a St.
Elizabeth. See Kempe, Book of Margery Kempe, p.154. Although this is likely to refer
to the writings of Elizabeth’s great-niece, Elizabeth of Toess (c.1294-1336), it may be
that both figures are conflated in the Book. For discussions of this, see Diane Watt,
Medieval Women’s Writing (Cambridge and Malden, MA: Polity Press, 2007), pp.8788, and Alexandra Barrett, ‘Margery Kempe and the King’s Daughter of Hungary’, in
Margery Kempe: A Book of Essays, ed. by Sandra J. McEntire (New York: Garland,
1992), pp.189-201.
200
are the occasion for Elizabeth’s works of mercy rather than equal participants in a
sacred community.56
Representations of charitable acts in late medieval hagiography, whilst deploying
a semiotics of self-effacement, are predicated on the glory such acts bestow upon the
holy person. Elizabeth of Hungary’s selfless acts in founding a hospital and subjecting
herself to the menial tasks of washing and feeding its inmates result in her
magnification as a superlative model of mercy and piety. Devotion to saints like
Elizabeth in late medieval England paralleled the use of charity as an important medium
through which social and economic alliances and prestige were defined. As Miri Rubin
argues,
Gift-giving was also part of the symbolic articulation of social and personal
relations, and is at any time an act of self-expression, of the presentation of one’s
innermost values. Charity cannot be satisfactorily understood as a purely altruistic
act since gift-giving is so rich in rewards to the giver’.57
56
Depictions of the sick and poor as bare life figures constitute an abiding motif in
articulations of saintly charity. For instance the Gilte Legende includes accounts of
Saints Giles (c.650-c.710) and Julian the Hospitaller (b. c.7 CE), both of whom are
partly-defined through their acts of mercy to the poor (Jacobus de Voragine, ‘St. Giles’,
GL, Vol. II, p.638; ‘St. Julian the Hospitaller’, GL, Vol I, p.144). The motif is
exemplified in the vita of Lawrence of Rome (c.225-258): when asked to present
treasures to the Roman Emperor, Decius (c.201 – 251 CE), Lawrence ‘gadred togedre
alle the pore, lame and blynde and presented hem before Decyen’ as Christ’s treasures
(Jacobus de Voragine, ‘St. Lawrence’, GL, Vol II, p.555).
57
Rubin, Charity and Community, p.1.
201
For the giver, these rewards could include social promotion and integration, esteem and
spiritual benefits such as the receipt of suffrages (prayers said by the living for the dead)
and the prospect of salvation after death. Charity is therefore to be seen ‘against the
background of prevailing understanding of property, community, salvation’.58 As an
economic and social transaction, it is bound by codes of reciprocation (encompassing
spiritual as well as material kinds).59 As the founding of late medieval hospitals was
very much tied to the idea of charity, this suggests that the implementation of social and
economic hierarchies was intrinsic to the way in which they were understood. But this
cannot be said of all healing spaces: the commitment of the monastic community
towards those inhabiting the infirmary was predicated, at least nominally, on the
economic and social equality of those who made up the community. But even here there
is evidence (discussed below) of the implementation of a (temporary) hierarchy between
the sick and the well. This suggests that the spaces provided for those who were sick or
incapacitated were ideologically invested and oriented towards a hierarchical
demarcation.
58
Rubin, ‘Charity and Community’, p.4.
59
Rubin argues that if such reciprocity is lacking, a ‘moral dissonance’ could set in
restricting further gift-giving. She proposes that such dissonance became a feature as
later medieval society changed (particularly after the Black Death), reducing the amount
of charitable donations to hospitals. See Rubin, Charity and Community, p.10.
Conversely, Peregrine Horden argues that the medieval idea of charity was too broad
and complex to be reduced to reciprocity. See Horden, ‘A Discipline of Relevance’,
pp.363-9.
202
Fig.12: Elizabeth of Hungary. Stained Glass Panel. 1400-1500. Chancel East Window,
St. Peter Mancroft, Norwich (reproduced by permission of St. Peter Mancroft,
Norwich).
203
The Deviant Bodies of the Infirmary
The detailed and precise stipulations pertaining to management of infirmary inmates in
monastic customaries reveals the extent to which the Christian imperative to care for the
sick could navigate between incorporation and exclusion. Whilst the religious practices
that constituted the lives of the enclosed are foregrounded in such documents, their
inclusion of medical language works to characterise the sick in terms of marginality and
deviance. A set of instructions produced for the Bridgettine order of sisters at Syon
Monastery in Isleworth, founded in 1415 by Henry V as part of his ‘great work’,
constituting the building of monasteries and a palace by the Thames to the west of
London, emphasises the importance of boundaries and division in relation to treatment
of the sick.60 These are included in a fifteenth-century document as additions to the
60
For background of Syon, particularly regarding its much discussed library, see
Edward Alexander Jones and Alexandra Walsham, eds., Syon and its Books: Reading,
Writing and Religion c.1400-1700 (Woodbridge: Boydell Press, 2010); Susan Powell,
Preaching at Syon Abbey: Working Papers in Literary and Cultural Studies (Salford:
University of Salford, European Studies Research Institute, 1997); Vincent Gillespie,
ed., Syon Abbey (London: The British Library in Association with the British Academy,
2001). On the importance of Syon to Henry V’s attempts to engender religious reform
in England, see Alexandra da Costa and Ann M. Hutchison, ‘The Brethren of Syon
Abbey and Pastoral Care’, in A Companion to Pastoral Care in the Late Middle Ages
(1200-1500), ed. by Ronald J. Stansbury (Leiden and Boston: Brill, 2010), pp.235-60.
204
monastic rule written in Middle English.61 One passage stipulates the places where the
sick are to be kept:
Wherfor, like as þer be dyuers infirmitees, so ther owen to be dyuers howses to
kepe hem in: one for al maner sekenes, as is the comen fermery; another for them
that be in recouerynge, as is the comen parlour; another for them that be distracte
of ther mendes; another for lepres, stondyng fer from al other, so ȝet that the
sustres may come to them & comforte hem.62
The diversity of illnesses necessitates the spatial partitioning, separating sufferers based
on their differing conditions and the particular stages of their illnesses. This bespeaks a
high level of spatial organisation and mobilisation of labour. The edicts also implement
a hierarchy where those who are nearest to regaining their health enjoy the communality
of the ‘parlour’, whilst the place housing lepers is to be ‘fer from al other’. Yet the
author(s) also stipulate that the leper house should be near enough so ‘that the sustres
may come to them & comforte hem’. Concern for the sick is balanced by the insistence
on effective management of these spaces. The ideal carer must therefore diligently serve
the sick, being expected to ‘chaunge ther beddes and clothes, ȝeve them medycynes, ley
to ther plastres, and mynyster to them mete & drynke, fyre &water, and [al other
nec]essaryes, nyght & day’; yet, she must also be:
61
As the Bridgettine order was based on the Augustinian one, they followed a modified
Augustinian rule known as St. Saviour’s Rule. Syon housed both male and female
religious; they occupied separate spaces within the convent.
62
London, BL Arundel MS 146, f. 97. This is printed in The History and Antiquities of
Syon Monastery, ed. by George James Aungier (London: Nichols, 1840), pp.395-6.
205
stronge & myghty to lefte them up & lede them from place to place, whan need is,
to the chirche or fermery chapel, &kan exhorte, styrre & comforte them to be
confessed & receyue the sacramentes of holy chirche.63
The language slips nicely between the medical and spiritual in relating how the duties of
the sisters must seamlessly perform both corporal and spiritual works of mercy.
Therefore, the instructions to the carers to change bedclothes and administer medicines
are blended with the imperative to motivate the patients’ liturgical participation. The
listing of these stipulations in unbroken prose suggests an understanding of the needs of
the ailing body of the infirmary inmate as concomitant with her need for penance and
receipt of the Eucharist. The performance of such care requires the alternation of rest
and segregation with movement, and a degree of communality required for liturgical
participation. But even when they are worshipping among the wider community, the
sick continue to occupy a privileged realm: they are physically lifted and motivated to
worship by their monastic carers. As their ailments are seen to affect their ability to
worship, they require both physical and spiritual care.
Nonetheless, it is the socially transgressive behaviour that infirmary inhabitants
display, according to the writer(s) of the Syon Additions, which places extreme demands
on their carers:
[Be] not squaymes to wasche them & wype them or auoyde hem, not angry nor
hasty or unpacient, thof one haue the vomet, another the fluxe, another the frensy,
whiche nowe syngethe, nowe cryethe, nowe laughethe, nowe wepethe, nowe
chydethe, nowe fryghtethe, nowe is wrothe, now wel apayde; ffor þer be some
sekenesses vexynge the seke so gretly &prouokynge them to ire, that the mater
drawen up to the brayne alyenthe ther mendes. And þerfor they owe to haue
63
Arundel MS 146, f. 97v.
206
moche pacience with suche, that they may therby gete them an euerlastyng
crowne. 64
This exhaustive list of the variety of behaviours to be expected of the sick shows a deep
curiosity and obsession on the part of the writer towards the extreme ways that illness
can be manifested. The list of behaviour types are characterised by proliferation,
multiplicity and variety, and the writer’s highly rhythmic expounding of these with an
enthusiastic employment of anaphora – ‘nowe syngethe, nowe cryethe, nowe laughethe,
nowe wepethe, now chydethe’ – works to convey an image of the infirmary as a place
of unrelenting noise and exaggerated behaviour. In this way, it is quite at odds with the
insistence of silence, devotion and continence attendant upon all other spaces in the
monastery. The writer’s concern with what is perceived as the uncouth behaviour of the
sick mingles apprehensions towards bodily excretion (bleeding, vomiting) with vocal
ejections associated with spontaneous and uncontrolled behaviour. These outward
manifestations of illness are paralleled or instigated by the internal movement of
excessive humours, or ‘mater’, going to the brain and diminishing the mind. The phrase
used in this context, ‘alyenthe the mendes’, connotes irrationality and derangement, as
well as estrangement from God.65
64
Arundel MS 146, ff. 97v-98.
65
‘alienen, v.’, MED, http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED1117 [accessed 20 November 2014]. Its etymon, the classical
Latin adjective, aliēnus, carries a wide range of meanings including unnatural,
unconnected, foreign, unrelated, of a different species, and repugnant. See ‘alien, n. and
adj.’, OED
207
In this passage, Syon’s infirmary inmates are constituted, through a coalescence
of discourses: the language of moral or physical disgust, preoccupied with the
fragmented, diseased body is folded with a medical, theoretical register, explaining the
behaviour of the sick through discussion of humoral dispersal; this is overlaid with the
rhetoric of religious salvation stressing the divine benefits that accompany the carer’s
patience and endurance when dealing with the sick. This discursive interlacing works to
articulate a ‘knowledge’ of the institutional subject through the image of the deviant,
self-estranged and privileged body marked by its wayward humours, its incontinence
and its potential of engendering the salvation of its carers. Crucially, this passage is
written in a monastic customary, a text that would regularly have been read out to the
monastic community. In this sense, it outlines behaviours that are expected of infirmary
inmates: the sick body is already inscribed with the deviance, or the alterity, it is
expected to perform in the enclosed, liminal space of the infirmary.
The knowledge of the infirmary subject set out in the Syon Additions aligns with
Foucault’s argument that an intrinsic feature of medical discourse is the connection it
implements between disease and morality:
Medicine must no longer be confined to a body of techniques for curing ills and of
the knowledge that they require; it will also embrace a knowledge of healthy man
[…]. In the ordering of human existence it assumes a normative posture, which
authorizes it not only to distribute advice as to healthy life, but also to dictate the
standards for physical and moral relations of the individual and of the society in
which he lives [Original emphasis]. 66
http://www.oed.com.ezproxy.lib.bbk.ac.uk/view/Entry/4988?rskey=2feIXw&result=1&
isAdvanced=false [accessed 20 November 2014].
66
Foucault, Clinic, pp.39-40.
208
Medicine, according to this view of its post-Enlightenment incarnation, becomes so
intrinsic to the way that the modern subject is conceived that it begins to define all
aspects of his being, encompassing both physical and moral characteristics. However,
such a medicalised culture is not exclusive to modernity: as we have seen, such ideas
can be clearly identified in the way that medical theory and care are interwoven with
ideas of moral and behavioural degeneration in the Syon Additions.
The idea of the infirmary as a space defined by dissolute behaviour does not just
refer to bodily imperatives. Customaries and ordinances make clear that the usual
rigorous commitment to worship, silence and work that (depending on the monastic
order) could characterise quotidian life for monastics, were relaxed in the infirmary.67
The convalescent nature of the infirmary and physical restrictions brought about
through illness meant that rest and relaxation were constitutive features. Monastics,
67
For discussion and descriptions of monastic routine, see C.H. Lawrence, Medieval
Monasticism: Forms of Religious Life in Western Europe in the Middle Ages, 3rd edn.
(Harlow and New York: Longman, 2001), pp.107-45; Martin Heale, ed., Monasticism in
Late Medieval England, c.1300-1535 (Manchester: Manchester University Press, 2009);
Gisela Muschiol, ‘Time and Space: Liturgy and Rite in Female Monasteries of the
Middle Ages’, in Crown and Veil: Female Monasticism from the Fifth to the Fifteenth
Centuries, ed. by Jeffrey F. Hamburger and Susan Marti, trans. by Dietlinde Hamburger
(New York and Chichester: Colombia University Press, 2008), pp.191-206; George
Ferzoco and Carolyn Muessig, eds., Medieval Monastic Education (London and New
York: Leicester University Press, 2000).
209
usually confined to silence, were permitted to speak to each other.68 As sickness was
mainly treated through diet, provisions of meats and delicacies, usually abstained from
in the monastery, were made available in the infirmary.69 Such privileges were not
exclusive to those who had fallen sick: in accordance with conventional medieval
surgical practice, otherwise healthy monks would undergo periodic phlebotomy, as part
of their general health regimen for prophylactic reasons a number of times in the year.70
The submission to this process required a monk to spend a number of days convalescing
in the infirmary during which he would be allowed the benefits of living under its
comparably relaxed conditions. Indeed, Mary Yearl suggests that the high number of
bloodletting sessions, made available at a number of English monasteries for individual
monks (in some cases as much as eight per year), could have functioned as a sort of
‘holiday’, enabling them ‘to sustain their commitment to the [monastic] life from one
period of rest to the next’.71
Indeed, the use of ritual to mark the inmate’s exit from the monastic community,
as well as his re-entry following his convalescence, underscores a perspective of the
68
Julie Kerr, Life in the Medieval Cloister (London and New York: Continuum Books,
2009), pp.76-77.
69
Barbara Harvey, Living and Dying in England, 1100-1540: The Monastic Experience
(Oxford: Clarendon Press, 1993), p.93.
70
Medical practitioners advised periodic phlebotomy as a prophylactic measure as part
of general maintenance of health. It was thought to expel excessive or corrupt humours.
See Pedro Gil-Sotres, ‘Derivation and Revulsion: The Theory and Practice of Medieval
Phlebotomy’, in Practical Medicine, ed. by Luis García-Ballester et al., pp.110-55.
71
Yearl, ‘Medieval Monastic Customaries’, p.189.
210
infirmary as a place set apart from the wider environment. The Barnwell Observances
outlines the ritual for minuti in specific terms: 72
Those who are to be bled must ask leave of the President in Chapter, and, when
this Chapter has terminated, having received a bleeding-license [licencia
minuendi], they are to go out of the Quire after the gospel at High Mass, and, at
the customary place in the Infirmary, are to be bled. 73
The process of leaving the quire and entering the infirmary must happen at a precise
time (after the gospel during Mass) and be sanctioned by the chapter president. The
instruction that the monk should leave mid-way through the liturgy lends a degree of
spectacle and performance to his departure. The customary goes on to stipulate that
whilst the brother is convalescing in the infirmary, during the days following his
bleeding, he must not enter the quire for the Hours (with the exception of special
occasions, such as in the event of the death of a fellow monk). In line with the more
moderate conditions of the infirmary, the instructions ordain that the infirmary master is
to serve the bled monk with whatever provisions (such as napkins and utensils) he
needs; additionally the infirmarer is to bestow upon the monk ‘all the solace and
benveolence that he can. For those who have been bled should, during this time, lead a
life of joy and amiability, of solace and cheerfulness’.74 The bled monks are required to
72
Minuti, the usual term employed in customaries for those undertaking phlebotomy,
was medieval shorthand for minutio sanguinis, or ‘lessening of blood’.
73
Barnwell Observances, p.198.
74
Barnwell Observances, p.202.
211
re-enter the community in a similarly ritualistic manner: ‘On the third day they should
enter the chapter-house, and, prostrating, beg for pardon’.75
A similar re-entry ceremony, for recovered infirmi, is outlined in another
customary from Syon abbey, this time pertaining to its male brethren:
W[han þe] clerkys ar comne, and the lesson is redde, yf any brother þat hath be
seek & is recouered of hys sekenes, & wylle ioyne hym to the convente & to ther
labours, he schal first ryse & take hys veyne [prostration in penance] for hys
defawtes &omissyons in the tyme of hys sekenes. And whan he hath take hys
penaunce, he schal go to hys place.76
The ‘defawtes and omissyons’ that the monk has committed in the time of his penance
can refer to the monk’s performance of any of the socially uncouth behaviours the sick
were thought to exhibit, as well as his indulgence in food and activities denied to the
rest of the community.77 Importantly, it is worth recalling that the sins that the monk has
75
Barnwell Observances, p.200.
76
London, Guildhall Library MS 25,524 (previously London, St. Paul’s Cathedral
Library MS 5), f. 7. The Guildhall manuscript represents the additions to the rule
pertaining to the monks at Syon. The corresponding passage in the nuns’ additions
(London, BL Arundel MS 146) is missing. For information on this manuscript, see N.R.
Ker, Medieval Manuscripts in British Libraries, Vol. I: London (Oxford: Clarendon
Press, 1969), pp.243-4.
77
The monastic constitutions of Lanfranc of Bec (1005-1089), archbishop of
Canterbury between 1070 and 1089, written for enclosed brethren at Canterbury, are
more specific on what the monk would be expected to confess: ‘“My Lord, I have been
long in the infirmary borne down by sickness; I have offended in matters of food and
drink and much else, and I have acted against our established discipline, and for this I
212
committed in the infirmary are pre-inscribed: the Syon Additions create a space for their
execution and deploy them in establishing the co-ordinates within which the infirmary
subject is defined. Such transgressions inform the articulation of healing in these texts.
They construct the infirmary as a place where the relaxed behaviour imputed onto its
inmates is intrinsically bound up with their malign or diseased state. This works to
suggest that movement from the infirmary to the chapter-house (where the restorative
ceremony takes place) signifies the passage from physical sickness to health, as well as
a corresponding movement from a state of sin to one of forgiveness.
The Infirmary and other Remedial Spaces
The rhetoric that constellates around the healing spaces of the hospital and the infirmary
encompasses medical, moral and spiritual modes. Medical knowledge is employed to
articulate the bodies of inmates in terms of excess and self-alienation, as well as to
frame the granting of dietary indulgence and aberrations from the monastic rule. It
shores up the over-riding tendency of institutional language to privilege the needs of the
indigent subject by circumscribing her both spatially and through a variety of imputed
behaviours, gestures and aspects. We have seen manifestations of this, ranging from the
bare-life demeanours of Elizabeth of Hungary’s charges to the erratic convolutions of
the Syon inmates. But the incorporation of medicine within a broader spiritual context is
signalled by the moral assignations of those housed in the infirmary. The customaries’
descriptions of rituals, marking the departure and return of monastics to and from the
beg of you absolution’. See The Monastic Constitutions of Lanfranc, ed. and trans. by
David Knowles (Oxford: Clarendon Press, 2002) p.119.
213
infirmary, encode transgressive imperatives; the textual enunciation of the infirmary is
predicated on the mapping of physical sickness or weakness onto spiritual or moral
degradation, and the ensuing restoration of physical and spiritual health. The presence
of a spiritual framework informing the way that the infirmary and hospital are imagined
by late medieval writers suggests that other spaces may be liable to a similar poetics. In
this section, I explore the replication of the symbolic movement between sin and
redemption, encoded in infirmary language, onto the spaces of the prison and purgatory.
Foucault argues that the subject’s incorporation of disciplined, regulated gestures is
conditioned by the resemblance of one institutional space to another (thus connecting
schools, hospitals, prisons).78 To what extent can we see the medieval subject of the
institutional imaginary being mediated through such similitude?
The vita of a thirteenth-century female ‘saint’ from Liege, Christina Mirabilis
(1150-1224), by the Dominican preacher and theologian, Thomas of Cantimpré (c.1200c.1265/70), comprises an affirmation of spiritual exemplarity through images of
confinement.79 Having lived a life as a humble and devout cowherd, Christina dies
young but is miraculously resurrected during her funeral mass; this event invests her
with extraordinary spiritual powers including metamorphosis and the ability to fly. This
78
‘Is it true that prisons resemble factories, schools, barracks, hospitals, which all
resemble prisons?’ See Foucault, Discipline and Punish, p.228.
79
Thomas of Cantimpré, The Middle English Life of Christina Mirabilis, in Three
Women of Liège: A Critical Edition of and Commentary on the Middle English Lives of
Elizabeth of Spalbeek, Christina Mirabilis, and Marie d’Oignies, ed. by Jennifer N.
Brown (Turnhout: Brepols, 2008), pp.51-84. Christina was also known as Christina of
St-Trond, referencing her birth-place in the Low Countries.
214
begins a phase of her life typified by her voluntary subjection to superlative tortures (as
a means to endure the pains of purgatory on earth) and her attempts to avoid social
contact by flying to tree-tops and church spires. 80 It is this tension between Christina’s
80
Scholarship on Christina’s vita has largely attempted to contextualise its unusual and
distinctive nature in relation to the orthodoxy of the Church and of important figures
such as her biographer, Thomas of Cantimpré. Herbert Thurston finds it to be fantastical
and unhistorical. See Thurston, Surprising Mystics (London: Burns and Oates, 1955),
p.149. Margot H. King identifies theological concepts of the stages of the soul’s
development in her life. See King, ‘The Sacramental Witness of Christina Mirabilis:
The Mystic Growth of a Fool for Christ’s Sake’, in Peaceweavers, Medieval Religious
Women, ed. by L.T. Shank and J.A. Nichols, Vol. II (Kalamazoo, MI: Cistercian
Publications, 1987), pp.145-64. Jennifer N. Brown argues that, in the lives of Christina
and her contemporaries, ‘their questionable spiritual practices are inextricable from an
orthodox depiction of confession and clerical obedience, creating both a tension and a
resolution for the medieval reader’. See Brown, ‘Gender, Confession, and Authority:
Oxford, Bodleian Library, MS Douce 114 in the Fifteenth Century’, in After Arundel:
Religious Writing in Fifteenth-Century England, ed. by Vincent Gillespie and Kantik
Ghosh (Turnhout: Brepols, 2011), pp.415-428 (p.416). Anke E. Passanier argues that
the representation of miracles of women like Christina reflects the hope invested in
them by Churchmen for inspiring ‘evangelical renewal’. See Passanier, ‘The Life of
Christina Mirabilis: Miracles of the Construction of Marginality’, in Women and
Miracles Stories: A Multidisciplinary Exploration, ed. by Anne-Marie Korte (Leiden:
Brill, 2004), pp.145-178. For more on the relationship between ecclesiastical orthodoxy
and female sanctity, see John H. Arnold, ‘Margery’s Trials: Heresy, Lollardy and
Dissent’, and Sarah Salih, ‘Margery’s Bodies: Piety, Work and Penance’, both in A
215
distinctive and extreme devotions and the more conservative community in Saint-Trond
which informs the various attempts to imprison her, described in the text. We are told
that after Christina has fled the presence of the community by residing in trees and the
tops of towers, ‘hir frendys – supposynge hir wode and ful of fendes – atte laste with
grete laboure toke hir and bonde hir with chaynes of yren’.81 Similar to the accounts of
caring and institutionalisation analysed in this chapter, the actions by Christina’s friends
are described as being motivated by concern for her. 82 Yet such care is implicated in
Christina’s general sufferings in the way that it obstructs her solitary devotions to God.
The necessity of Christina’s purgatorial suffering establishes a repetitive pattern in the
narrative, characterised by her fleeing from her family and friends, after which she is
captured and confined, ultimately leading to her escape through the intervention of
Christ.83
Companion to the Book of Margery Kempe, ed. by John H. Arnold and Katherine J.
Lewis (Cambridge: D.S. Brewer, 2004), respectively pp.75-94 and 161-76.
81
Thomas of Cantimpré, Christina Mirabilis, p.57.
82
Katheryn M. Giglio proposes that the response by Christina’s friends would have
been a conventional one to such behaviour. See Giglio, ‘Spirituality and SelfRepresentation in The Life of Christina Mirabilis’, Essays in Medieval Studies, 15
(2011), 115-7.
83
For a discussion of Christina’s incursions into the wilderness as constituting a vision
of a purgatorial, female ‘wild zone’, see Joanna Ludwikowska-Leniec, ‘Access Denied:
The Female “Wild Zone” in Visions of Purgatory by Christina Mirabilis’, in Thise
Stories beren Witnesse: The Landscape of the Afterlife in Medieval and Post-Medieval
Imagination, ed. by Liliana Sikorska (Frankfurt: Lang, 2010), pp.93-100.
216
Having escaped her friends’ chains, she returns to her voluntary endurance of
sufferings, which include her being crushed beneath a wheel and running through
thorny bushes being pursued by wild dogs.84 Her sisters and friends, convinced of her
demonic possession, employ a ‘ful wicked and ful strange man’ to capture her. In the
course of this attempt, he breaks her leg:
Then was she broghte home and hir sisters hyred a leche that shulde heel hir
broken legge. Thenne was she ladde in a chayer to Leody, and the leche knewe the
spirite of hire strengthe and bonde hir faste to a piler in a celer, wallid alle aboute,
and lokked faste the dore. Thanne hee bonde vppe hir legge with medecynnabil
clothes.85
Again, the agents whom Christina’s friends employ to retrieve or heal her are
characterised through a blend of violence and mercy. The ‘wicked’ man breaks her leg
in the act of capturing her; subsequently, the physician is hired to ‘heel’ her broken leg.
The fact that she is transported to the city of Leody, or Liège, and tied to a pillar in a
cellar, suggests that a kind of carceral space, perhaps a prison or a hospital, is being
referred to. In common with other late medieval healing spaces, this is represented
through the need to remove the subject from the community in order to effect healing.
The fact that the type of institution remains unspecified heightens the way it hinges
between a punitive and caring environment. In this sense, it is revealing that the
physician, who is retained to cure Christina’s injured leg and address the damage
84
In detailing her sufferings, Thomas of Cantimpré references the superlative and
violent sufferings with which the hagiographies of the female martyr saints of the early
Church are described but gives them the contemporary setting of the thirteenth-century
Low Countries. See Brown, ‘Introduction’, in Three Women of Liège, p.6.
85
Thomas of Cantimpré, Christina Mirabilis, p.62.
217
wrought by her captor, executes his treatment in overwhelmingly punitive terms. His
cautious act of locking her within an impregnable space, ‘wallid alle aboute’, suggests a
greater concern with her protean and evasive skills than with curing her injury. Even the
‘medecynnabil clothes’, or bandages, he uses to bind up her leg assume a menacingly
restrictive character.86
However, the ineffectual nature of such treatment is immediately manifested once
Christina is placed within the institution:
But when the leche was gon, she drowe hem [i.e. the bandages] of ageyne and
thoghte vnworthy to haue annothere leche to hire woundes but oure sauyour Jhesu
Cryste, and allemyghty God deceyued hir not. For on an nyghte, whan the Holy
Goost felle in hire, the bondes that she was tyed with were loused and she, alle
hoole and harmeles, walked in the celar flore, daunsynge and blessynge oure
Lorde to whom allone sche hadde chosen to lyue and to dye.87
Rather than countering the clumsiness of the strong man who injured Christina, the
fastidious but vain efforts of the physician to enclose her in the prison/infirmary also
reveals him to be inept. Consequently, this episode affirms the transcendence of
spiritual over earthly medicine. This is exemplified by the miraculous loosening of
Christina’s ‘bondes’ and the healing of her leg, allowing her to walk and even dance on
the cellar floor. By querying the divisions between mercy and punishment (itself related
to the text’s wider undermining of the boundaries between madness and sanctity),
Christina’s vita participates in the ambiguities that constitute representations of late
86
This also corresponds with an idea throughout the vita, of Christina being imprisoned
or encased in her body. See Jennifer N. Brown, ‘Christina Mirabilis: Astonishing Piety’,
in Three Women of Liège, pp.219-245 (p.234).
87
Thomas of Cantimpré, Christina Mirabilis, pp.62-3.
218
medieval institutional spaces. Indeed, the implication of healing spaces in terms of the
symbolic movement from the physical to the spiritual, or from sin to salvation, is
exemplified when Christina picks a stone from the cellar floor, ‘and in an houge spirite
she made the walle thurgh. And […] hir spirit artyd abouen right with the selfe body of
verrey fleshe, as hit is seide, flowe forth as a bridde in the eyre’.88 Christina’s
overcoming of her material restrictions and ailments, framed through the image of her
spirit flying through the air and carrying the weight of her fleshly body, attests to the
ultimate porousness of the prison walls.89
The cultural configuration of the prison in terms of spiritual liberation is one
identified by Megan Cassidy-Welch in her study of imprisonment in the later Middle
Ages. Cassidy-Welch identifies how the prison could signify both spatial confinement
and ‘the promise of eternal liberation through participation in the Christian devotional
economy’.90 Indeed, these powerful significations may account for why imprisonment
88
Thomas of Cantimpré, Christina Mirabilis, p.63.
89
Megan Cassidy-Welch, Imprisonment in the Medieval Religious Imagination c.1150-
1400 (Basingstoke, Hampshire and New York: Houndmills, 2011), p.2.
90
Cassidy-Welch, Imprisonment, p.4. Guy Geltner discusses how the gradual
emergence of prisons over the later Middle Ages as characteristic features of the urban
topography across Europe signalled the development, on the part of authorities and
urban administrators, of ‘an impulse not simply to eradicate, but rather to contain and
maintain deviancy’ [original emphasis]. See Guy Geltner, The Medieval Prison: A
Social History (Princeton and Oxford: Princeton University Press, 2008), p.5. See also
Jean Dunbabin, Captivity and Imprisonment in Medieval Europe, c.1000-c.1300 (New
York and Basingstoke: Palgrave Macmillan, 2003).
219
existed as an idea long before it was applied or regulated in any systematic way. 91 Such
ideas were grounded in tropes shared by classical and early Christian authors of the
attainment of intellectual or spiritual development through suffering in confinement or
exile.92 According to this perspective, imprisonment offered a powerful model for
imaging the constrictions of the body and the potential of the soul’s ultimate divine
liberation. For Cassidy-Welch, the prison serves as a metaphor in Christina’s vita, ‘as it
allows the reader to understand that the constraints of the physical body are limiting
only until the soul is freed, and that this particular sort of spiritual liberty can only come
with God’s grace’.93 However, Christina’s repeated confinement suggests that the allure
91
Even though the thirteenth century saw an increase in the administration and
regulation of English prisons, they still remained chaotic spaces; see R.B. Pugh,
Imprisonment in Medieval England (London and New York: Cambridge University
Press, 1968), pp.26-47.
92
A prominent example is the Consolation of Philosophy by the Roman philosopher
Boethius (c.480-524), featuring its imprisoned or exiled author’s dialogues with Lady
Philosophy on the vagaries of fortune. It remained highly influential in the late medieval
period and the trope of the imprisoned writer musing on philosophical questions is
repeated in Thomas Usk’s Testament of Love and James I of Scotland’s (c.1394-1437),
The Kingis Quair. See Elizabeth Elliot, Remembering Boethius: Writing Aristocratic
Identity in Late Medieval French and English Literatures (Farnham and Burlington,
VT: Ashgate, 2012), and Alastair J. Minnis, eds., Chaucer’s Boece and the Medieval
Tradition of Boethius (Cambridge: D.S. Brewer, 1993). Early Christian martyrological
narratives also imagined prison as a space of spiritual development. See Geltner, The
Medieval Prison, pp.83-9.
93
Cassidy-Welch, Imprisonment, p.88.
220
of the prison, in her vita, resides in the perpetual movement between captivity and
release. In the same way that Christina is resurrected from death twice in the narrative,
the edifying potency of imprisonment consists in the perpetual return to the body as
much as the fantasy of its effacement. Likewise, the ambiguous role of medicine in the
vita navigates between attesting to transcendence and an affirmation of materiality.
Medicine is not included in the text simply as an example of a material, worldly set of
concerns to be overcome by the spirit. It also serves as an important means through
which spiritual health is mediated, even as it is associated with dull and ineffectual
practitioners.
Again, medical healing shadows Christina’s final confinement when her friends
bind her to a wooden yoke, feeding her with meagre amounts of bread and water. This
is inevitably followed by multiple other sorrows: ‘Wherfore hire buttokes were al to
froten with the hardnes of the tree and hir shuldris festird, and she was with this waxen
febil and feynte and myghte not ete hire brede’.94 This time Christ brings about a
distinctive miracle:
For hire maydenly pappes bigan to sprynge licoure of ful swete oyle, and that toke
she and sauerd hir brede with alle and hadde hit for potage and oynemente. And
sche enoynted therewith the woundes of hire festirde membrys.95
Christina’s miraculous exuding of oil serves a number of purposes: it savours her bread,
it allows her to make soup and it serves as a medical ointment for her wounds.96 The oil
94
Thomas of Cantimpré, Christina Mirabilis, p.63.
95
Thomas of Cantimpré, Christina Mirabilis, p.64.
96
On women’s bodies becoming a source of their own food, see Bynum, Holy Feast,
p.122.
221
possesses physical healing qualities, as other oils used for medical purposes, but it is
also spiritually invested through its miraculous properties and sacramental associations.
Medical healing is once again affirmed, even as it is rendered useless by divine
efficacy.97
97
Christina’s vita, along with those of other thirteenth century beguines (women who
lived in semi-enclosed religious communities) had wide circulation through late
medieval Europe and attracted a lay, largely female, readership. There is one extant
Middle English version of her vita, a fifteenth century manuscript – Oxford, Bodleian
Library, MS Douce 114 – that also includes the lives of her contemporary beguines, all
from Liège, Elizabeth of Spalbeck (c.1246-1304) by Philip of Clairvaux (d.1273) and
Marie d’Oignies (c.1170-1213) by Jacques of Vitry (c.1160-1244). See Sarah M.
MacMillan, ‘Asceticism in Late-Medieval Religious Writing: Oxford, Bodleian Library,
MS Douce 114’ (unpublished doctoral thesis, University of Birmingham, 2010). This
manuscript was held at a Carthusian library at Beauvale in Nottingham and therefore is
unlikely to have found a lay readership. However, the reference to the life of Marie
d’Oignies in the Book of Margery Kempe, whose own devotions paralleled those of the
beguines, does suggest that such works did reach a lay audience in England. See Brown,
‘Introduction’, in Three Women of Liège, pp.9-16. The Middle English version of
Christina’s life attests to the continued interest in female sanctity in the fifteenth century
amongst lay readers. Its inclusion of anti-heretical material would have made it
applicable to the Church’s attempts to battle lollardy in fifteenth-century England. See
Brown, ‘Gender, Confession, and Authority’, p.416. On the relationship between
Thomas of Cantimpré’s thirteenth-century Latin version and the subversion of
222
Christina’s series of confinements should also be seen as part of the enterprise that
determines her post-resurrection life, her experience of purgatorial suffering. Following
her early death, she visits purgatory, ‘a loothly place ful of mennes soulles’.98
Subsequently, she is led to heaven where Christ gives her the choice to remain there or
to return to earth, ‘to suffre peynes of an vndeedly soule by a deedly body withouten
harme of hitself and to delyuere with thy peynes alle thos soulles of the whiche thou
haddest pite in the place of Purgatorye’.99 Christina returns to the world where her
sufferings are undertaken to enable delivery of purgatorial souls and, by pietistic
example, to motivate the living to repent. Her vita thus offers a striking visualisation of
this space, particularly in the episodes of her confinement and release. 100
Indeed, Thomas of Cantimpré’s writing of her life coincided with a growing
affirmation of purgatory by Church theologians and authorities throughout the thirteenth
Catharism in Europe, see Patricia D. Kurtz, ‘Mary of Oignies, Christine the Marvellous,
and Medieval Heresy’, Mystics Quarterly, 14:4 (1988), 186-196 (p.187).
98
Thomas of Cantimpré, Christina Mirabilis, p.55.
99
Thomas of Cantimpré, Christina Mirabilis, p.56.
100
Robert Sweetman argues that the vita takes the form of an exemplum or purgatorial
sermon. See Sweetman, ‘Christine of St. Trond’s Preaching Apostolate: Thomas of
Cantimpré’s Hagiographical Method Revisted’, Vox Benedictina, 9 (1992), 67-97, and
‘Thomas of Cantimpré, Mulieres Religiosae, and Purgatorial Piety: Hagiographical
Vitae and the “Beguine Voice”’, in A Distant Voice: Medieval Studies in Honour of
Leonard E. Boyle, ed. by Jacqueline Brown and William P. Stoneman (Notre Dame,
1997), pp.606-28. See also Ludwikowska-Leniec, ‘Access Denied’, p.93.
223
century, culminating with its official ratification by the Council of Lyon in 1274.101
This middle space between heaven and hell, temporarily housing the souls of sinners
whilst they are purified through punishment from the sins they committed in their
lifetimes, proved compelling within late medieval European culture.102 Part of its allure
was its alignment of the world of the living with that of the dead, and its affirmation that
‘the trial to be endured by the dead may be abridged by the intercessory prayers, the
“suffrages” of the living’.103 It offered a cosmological and transactional framework
which could mediate even the most pedestrian features of quotidian life. The temporary
and punitive nature of purgatory constituted it as an exemplary carceral space. Its
thirteenth-century establishment, as a discrete otherworldly realm, resonates with the
broader interests in penal confinement in late medieval Europe, and the rise of
101
Jacques Le Goff, The Birth of Purgatory, trans. by Arthur Goldhammer (Aldershot:
Ashgate, 1984), p.237.
102
Prior to the twelfth century, the Christian otherworld was thought to comprise only
of heaven and hell. The idea of purgation was regarded as a feature of the afterlife, but it
was usually imagined to be consigned to the margins of either heaven or hell. The
growing emphasis of purgation, influenced by a greater focus on confession and
penance following the Fourth Lateran Council, resulted in the idea that purgatory
comprised a third space separate from heaven and hell. See Le Goff, Birth of Purgatory,
pp.1-7, and Graham Robert Edwards, ‘Purgatory: “Birth” or Evolution?’, Journal of
Ecclesiastical History, 36 (1985), 634-46.
103
Le Goff, Birth of Purgatory, p.11. These suffrages included payment by relatives of
the dead to the clergy to have masses said that would help the souls out of purgatory.
The souls’ progress was thus seen as expedited as much by the prayers of the living as it
was by the sufferings the souls would endure for their own past actions.
224
penitential and confessional spiritual modes.104 The establishment of purgatory as a
mainstay of popular beliefs and practices owed much to the way it was elucidated and
visualised in medieval writings.105 A genre of visionary literature, detailing the accounts
of visitations made by penitents to the otherworld and featuring their detailed and
fantastical descriptions of its precincts, was highly popular amongst readers in England,
as well as throughout Europe.106 The otherworld, in its non-material, abstract yet highly
regulated nature, can therefore be understood to constitute an exemplary model of
imaginary, institutional space.
An example of this genre, The Revelation of the Monk of Eynsham, incorporates
features of the regulatory language constitutive of descriptions of the hospital and
prison. The text is attributed to Adam (c.1155-1233), chronicler and abbot of the
Benedictine abbey of Eynsham, whose brother, Edmund, was thought to have been the
monk who experienced the vision.107 A fifteenth-century Middle English translation
104
Cassidy-Welch, Imprisonment, p.90. See also Andrew Stotnicki, ‘God’s Prisoners:
Penal Confinement and the Creation of Purgatory’, Modern Theology, 22:1 (2006), 85110.
105
See Stephen Greenblatt, Hamlet in Purgatory (Princeton and Oxford: Princeton
University Press, 2002), p.50.
106
For a collection of such purgatorial writings, preceding Dante Aligheri’s (c.1265-
1321) epic appropriation of the genre in the Divina Commedia, see Eileen Gardiner, ed.,
Visions of Heaven and Hell before Dante (New York: Italica Press, 1989).
107
D.H. Farmer, ‘Adam of Eynsham’, ODNB
http://www.oxforddnb.com/view/article/48313 [accessed 29 Jan 2013]. This is the same
225
outlines the punishment in purgatory of a doctor of law and connects ideas of morality,
sickness and punishment. Purgatory here, as in many other such accounts, is organised
into different sections where specific types of sins are punished. The visiting monk
recognises the doctor of law, whom he knew in life, being punished for the sin of
sodomy in the space reserved for this. The taboo-status of this category of sin is
signalled through its negation: whilst the chapter’s rubric makes its subject explicit, ‘Of
the vnclene and foule vyce and synne of sodemytys’, the narrator invokes it in terms of
a pious refusal to name: ‘that foule synne, the whiche oughte not be namyd not only of a
Crystyn man but also of none hethyn man’. 108 This rhetorical manoeuvre brackets
sodomy as a superlative vice, whilst eliding its particular characteristics. Sodomy is thus
constituted in terms of a semantic opacity, typical of its articulation by late medieval
writers, allowing it to evoke a host of ‘deviant’ sexual practices.109
author of the life of St. Hugh discussed above. See also Gardiner, ed., Visions of Heaven
and Hell, pp.254-6.
108
Adam of Eynsham, The Revelation of the Monk of Eynsham, ed. by Robert Easting,
EETS no.318 (Oxford and New York: Published for the Early English Text Society by
Oxford University Press, 2002), p.79. References to sodomy as an unmentionable
category were typical of its appearances in late medieval writings. See Robert Mills,
‘Gender, Sodomy, Friendship, and the Medieval Anchorhold’, Journal of Medieval
Religious Cultures, 36:1 (2010), 1-27 (p.15).
109
Karma Lochrie makes the point that medieval theologians ‘located [sodomy’s]
sinfulness and its horror in its most deeply conflicted gender attributes: its passivity […]
and unrestrained desire, an ‘abominable’ state that could not be named without danger
of contamination and corruption’. See Lochrie, Covert Operations, p.191. In this sense,
226
The punishment that the souls guilty of sodomy, like the doctor of law, undergo is
its enforced re-enactment with demonic figures:
Certen grete monstrus, that ys to seye grete bestys onnaturally schapyne, schewyd
hem-selfe in a fyrye lykenesse, horrabulle and gastfulle to sight, and oftyn-tymes
vyolently came apone hem and also in a fowle damnable abusion compellyd hem
to medylle with hem, howe-be-hyt that they refusyd and wulde hyt not. I abhorre
and ame asschamed to speke of the fowlnesse and vnclenes of that same synne.110
The main verb employed to describe the action in this passage, ‘medylle’, signifies
sexual intercourse but, more generally, it connotes blending or mixing. It is this nonspecified merging of forms that informs the narrator’s expressions of horror and disgust
(conveyed through the adjectives ‘horrabulle’, ‘gastfulle’ (signifying dreadful) and the
repetition of ‘fowlnesse’ and ‘vnclenes’). Subsequently the lawyer is completely
any sexual act that was seen by Church authorities as un-natural and non-normative
(including acts within heterosexual marriage) could be deemed as sodomitical. Michel
Foucault famously referred to its medieval constitution as an ‘utterly confused
category’. See Foucault, History of Sexuality, I, p.101. For other discussions of
medieval sodomy, see Dinshaw, Getting Medieval, pp.100-42; Glenn Burger, Chaucer’s
Queer Nation (Minneapolis: University of Minnesota Press, 2003), pp.119-159; Mark
Jordan, The Invention of Sodomy in Christian Theology (Chicago: University of
Chicago Press, 1997), pp.154-58; Robert Mills, ‘Seeing Sodomy in the Bibles
moralisées’, Speculum 87.2 (2012), 413-68; Kim M. Phillips, ‘“They Do not Know the
Use of Men”: The Absence of Sodomy in Medieval Accounts of the Far East’, in
Medieval Sexuality: A Casebook, ed. by April Harper and Caroline Proctor (New York
and Abingdon: Routledge, 2008) pp.189-208 (pp.195-7).
110
Adam of Eynsham, Monk of Eynsham, p.79.
227
consumed: ‘and by thoo tormentys he was brought as to nought and dyssoluyd by
strenthe and hete of fyre and so made lyquyd, as led ys whenne hyt ys multe’.111 The
description of these torments resonates with the expressions of disgust in Elizabeth of
Hungary’s vita and the Syon Additions, where bodily excretions or uncontrolled
gestures are both the subject of the authors’ captivated interest and aversion. In each
case, disgust is linked to the loss of bodily integrity. 112
Just as the representations of the infirmary and hospital, explored above, link
moral states with sickness and disease, the Monk of Eynsham depicts the lawyer’s sinful
state in terms of bodily ailments. We are told that, when alive, the lawyer fell grievously
ill not only as a consequence of his sexual sins but also due to his coveting of money
belonging to the Church:113
Sothely, hyt was done of a meke dispensacion of oure Sa[u]yur, that he shulde by
the schorge of sekenes and sorowe dispose to corect and amende hys synful
111
Adam of Eynsham, Monk of Eynsham, p.87.
112
This idea is informed by Mary Douglas’s well-known argument that cultural ideas of
purity are established and maintained by the institution of physical and symbolic
boundaries. See Douglas, Purity and Danger: An Analysis of Concepts of Pollution and
Taboo (New York: Routledge, 1966).
113
This reflects the way that sodomy was sometimes conflated with a host of sins such
as greed, gluttony and pride by religious writers. See Mills, ‘Seeing Sodomy’, p.423.
The sin of covetousness may also be introduced in the Monk of Eynsham to implicate
the lawyer with a type of sin more typically connected to his profession; see Jill Mann,
Chaucer and Medieval Estates Satire: The Literature of Social Classes and the General
Prologue to the Canterbury Tales (Cambridge and London: Cambridge University
Press, 1973), pp.86-90.
228
leuyng, […]. Bu[t] he contrary-wyse was ouer-carkefulle of hys bodely hel[þ]e,
the whyche he louyd ouer-mekyl, […], wherfore he neuyr wolde dyspose hym to
be confest of hys synys and specialy of his fowle and onclene leuyng, for the
helthe of his sowle […]. Than the he[u]ynly leche, oure Sauyur, seyng that he was
neuer in his dayes the bettyr for the sekenesse the whiche he hadde for his
warnyng, the whyche he schoyd and gaue vnto hym for a gostely medeson, nethir
wente owte of hys onclene leuing, in the whiche vnclene leuing he was in by the
affliccyon of hys grete sekenesse. […] Oure Lord Ihesu Crist mercefully putte an
ende of hem in hys dethe.114
The onset of the lawyer’s sickness is both a punishment for his sins and a warning to
amend his lifestyle. Yet instead of using the occasion of his bodily sickness to bring to
mind the ‘helthe of his sowle’, he remains vainly focused on the body becoming ‘ouercarkefulle’, or overly anxious, about his physical health. The ambiguity of the claim that
he indulged in unclean living ‘by the affliccyon of hys grete sekenesse’ implies both
that he was sick as a result of his living and that his moral failing was his great sickness;
the division between cause and effect, or between moral deviance and bodily sickness,
is queried.
The resemblance of purgatory to the infirmary is suggested by the familiar
representation of Christ as a merciful and benevolent ‘leche’. Just as the infirmary is
constituted in terms of the patient, glorified carer ministering to the loathsome and
erratic patient, the Monk of Eynsham sets up a similar dynamic in the image of Christ
dispensing ‘gostely’ medicines in order to bring the penitent back to health. The death
that Christ mercifully inflicts on the lawyer is not the failed result of this endeavour, but
merely the continuation of his sufferings in reparation for his sins. In keeping with the
soteriological possibilities intrinsic to the constitution of the remedial imaginary, the
Eynsham monk’s guide in the other world, St. Nicholas, in answer to the monk’s
114
Adam of Eynsham, Monk of Eynsham, p.83.
229
question of the lawyer’s fate, does not foreclose the possibility of his salvation:
‘“Whanne the daye of dome ys cumme, thenne schall Crystys wille be fulfyllede”’.115
Purgatory, then, reflects the aberrant space of the monastic infirmary: just as the
logic of the infirmary implicates the subject in terms of deviation from the monastic
rule, the punishments of purgatory in the Monk of Eynsham feature monstrous reenactments of the very sins which have led to the penitent’s otherworldly incarceration.
Again, the liquefied bodies of purgatory, rendered through a register of disgust, parallel
the visceral bodies that enable the sanctification of saints and carers in the hospital or
infirmary. As the ethics of charity affirm the spiritual rewards to the giver, the deviance
unleashed in purgatory is delimited within a highly-ordered, transactional system
between the living and the dead.
Whilst the poor and sick in the vita of Elizabeth of Hungary and other saints’ lives
are depicted as ciphers of the distinctive piety of the saint, the references to phlebotomy
in monastic customaries show how each member of a community can, at some point, be
constituted as a ‘sick’ subject. In one sense, this bespeaks the universal framework
informing the institutional imaginary, where physical illness is translated into the
spiritual sickness characteristic of living in the world. In the vita of Christina the
Astonishing, this enables a hierarchy where the jailer-physician called to heal her
broken leg acts as a foil to the physical and spiritual efficacy of Christ-as-healer. Yet the
consistent interest in representing bodily sickness and medical healing, in this text and
the others analysed in this chapter, reveal how medicine is a constitutive force in the
way that remedial spaces from the infirmary to the prison to purgatory are imagined.
115
Adam of Eynsham, Monk of Eynsham, p.87.
230
These zones resemble each other in the way they visualise ideas of freedom and
salvation through the medium of the incarcerated and ailing body.
231
CHAPTER FOUR
The ‘Scabbe of Synne’: Leprosy and its Representations
In Robert Henryson’s (c.1460-1500) Middle Scots poem, the Testament of Cresseid, the
connection between sickness and morality is affirmed through the affliction of its
protagonist, Cresseid, with leprosy. Henryson begins his version by invoking Chaucer’s
Troilus and Criseyde and asks ‘Quha wait gif all that Chauceir wrait was trew? (65)’.1
This questioning of Chaucer’s veracity appears to revolve around the issue of his
representation of Criseyde’s infidelity in abandoning Troilus for the Greek warrior
Diomede, and the exemption from punishment she is subsequently afforded. Henryson
attempts to offer a corrective version featuring Cresseid’s abandonment by Diomede,
followed by her subsequent, and unspecified, dishonourable behaviour amongst the
Greeks.2 Addressing her directly, Henryson’s narrator asks:
1
References to and citations of The Testament of Cresseid, by line number, are from
The Poems of Robert Henryson, ed. by Denton Fox (Oxford: Clarendon Press, 1981),
pp.111-31.
2
Derek Pearsall argues that Henryson’s version is a response to Chaucer’s leaving
Criseyde’s ‘moral position unresolved’. See Pearsall, ‘“Quha wait gif all that Chauceir
wrait was trew?” Henryson's Testament of Cresseid’, in New Perspectives on Middle
English Texts: A Festschrift for R.A. Waldron, ed. by Susan Powell and Jeremy J. Smith
(Cambridge: D.S. Brewer, 2000), pp.169-82 (p.173). George Edmondson claims that
Henryson’s text should be best understood as a judgement on and negation of Chaucer’s
text rather than one of lineage and inheritance. See Edmondson, ‘Henryson's Doubt:
232
[…] how was thow fortunait
To change in filth all thy feminitie,
And be with fleschelie lust sa maculait,
And go amang the Greikis air and lait,
Sa giglotlike takand thy foull pleasance!
I haue pietie thow suld fall sic mischance! (79-84).
Cresseid’s indulgence in sexual pleasure has transformed her femininity into ‘filth’, and
this moral transformation is subsequently embodied when the gods inflict her with
leprosy.
This connection between moral behaviour and disease is substantiated by
Henryson’s recourse to medical learning in describing the onset of Cresseid’s leprosy.
After Cresseid has blamed the gods for Diomede’s abandonment and for her subsequent
destitution, they convene to discuss her punishment. This results in Saturn and Cynthia,
goddess of the moon, afflicting her with leprosy through a series of performative
utterances.3 The presence of both deities here reflects the medical belief that the
astrological confluence of the moon and Saturn could engender leprosy.4 The situation
of the gods’ punishment within a medical framework is maintained when Saturn
Neighbors and Negation in The Testament of Cresseid’, Exemplaria, 20:2 (2008), 165196.
3
The term ‘performative utterance’ refers to J.L. Austin’s speech-act theory and his
identification of ‘illuctionary acts’ where language, particularly ceremonial language, is
used to achieve or enact something, instead of merely representing something. See
Austin, How to Do Things with Words, 2nd edn., ed. by J.O. Urmson and Marina Sbisà
(Oxford: Clarendon Press, 1975), pp.94-108.
4
Carole Rawcliffe, Leprosy in Medieval England (Woodbridge: Boydell Press, 2006),
p.101.
233
pronounces that he will remove Cresseid’s beauty and ‘change thy mirth into
melancholy’ (316); an excess of the humoral fluid, black bile, or melancholy, was
thought by medical writers to be a principal cause of leprosy.5 As the gods continue
with their pronouncement, they outline the principal symptoms of the condition, as well
as the social ostracism it was seen to engender:
‘Thy cristall ene mingit with blude I mak,
Thy voice sa cleir vnplesand hoir and hace,
Thy lustie lyre ouirspred with spottis blak,
And lumpis haw appeirand in thy face:
Quhair thow cummis, ilk man sall fle the place.
This sall thow go begging fra hous to hous
With cop and clapper lyke ane lazarous’ (337-43).
The dramatic disintegration of Cresseid’s beauty is emphasised: her clear voice is to
become hoarse and croaky; her ‘lustie lyre’, or beautiful skin, will be covered with
black spots. Whilst these transformations appear to her, and those who see her, as
sudden, the reader, through being accorded access to the gods’ dispensation of
punishment upon her, understands the hidden machinations through which her offenses
have been transformed into physical blemishes and deformities.
Whilst the medical understanding of the causes and symptoms of leprosy is
evoked here to describe the transformation of moral behaviour into physical disease,
this passage is ambiguous as to the particular acts that are being punished. As
5
Critics have commented on the close alignment between Henryson’s description of
leprosy in this poem and contemporary medical descriptions of the condition. See
Marshall W.Stearns, ‘Henryson and the Leper Cresseid’, Modern Language Notes, 59:4
(1944), 265-9, and Beryl Rowland, ‘The “seiknes incurabill” in Henryson's Testament
of Cresseid’, English Language Notes, 1 (1964), 175-77.
234
mentioned, the poem’s opening stanzas insist upon Cresseid’s sexually licentious
behaviour, and many of its critics accept that as the reason why she is struck with
leprosy.6 But the gods’ vengeful convention suggests that it is her blasphemy that is
being punished. The matter is confused even further when, later in the poem, the
narrator claims that she suffers both for betraying Troilus’s love (613-6) and as a result
of the inevitable result of the turning of the wheel of fortune (461-9). Throughout the
poem, then, the moral significance of leprosy is constantly shifting and ambiguous.
This feature suggests that Henryson’s poem does not differentiate itself from
Chaucer’s poem as much as its opening lines, as well as its critics, affirm: it aligns the
uncertain significations of leprosy with the indeterminacy with which lovesickness is
represented in Troilus and Criseyde.7 The two poems thus share a concern with the way
that the body both manifests internal, subjective states and simultaneously triggers an
obfuscating semantics of disease. As seen above in relation to the figure of the patient,
6
See Pearsall, ‘Henryson’s Testament’, pp.175-6; Rowland, ‘The ‘seiknes incurabill’’,
pp.175-7; Lee W. Patterson, ‘Christian and Pagan in The Testament of Cresseid’,
Philological Quarterly, 52 (1973), 697-8; Saul Nathaniel Brody, The Disease of the
Soul: Leprosy in Medieval Literature (Ithaca, NY: Cornell University Press, 1974),
p.175.
7
The depiction of Troilus’s love as illness, whilst a feature in Giovanni Boccaccio’s
(1313-1375) Il filostrato, Chaucer’s principal source for Troilus and Criseyde, is
developed more completely in Chaucer’s poem. For a study of the differences between
both texts, see Barry Windeatt, ‘Chaucer and the Filostrato’, in Chaucer and the Italian
Trecento, ed. by Piero Boitani (Cambridge and New York: Cambridge University Press,
1983), pp.89-114.
235
in Chaucer’s text, the description of the symptoms of Troilus’s lovesickness for
Criseyde, his loss of appetite and insomnia, foregrounds their revelatory capacity:
And fro this forth tho refte hym love his slep,
And made his mete his foo, and ek his sorwe
Gan multiplie, that, whoso tok kep,
It shewed in his hewe both eve and morwe.
Therfor a title he gan him for to borwe
Of other siknesse, lest men of hym wende
That the hote fir of love hym brende,
And seyde he hadde a fevere and ferde amys (I, 484-91).
As his sorrows proliferate, they become more susceptible to bodily imperatives: his
‘hewe’ becomes permanently altered, revealing his lovelorn state to anyone who
notices. But this overwhelming and potentially compromising condition, threatening to
undermine his knightly stature, is hidden by his excuse that he is suffering from other
sicknesses. In the courtly world of Chaucer’s Troy, lovesickness, as distinct from fever,
carries suggestions of weakness, moral instability, and culpability.8
There are indeed clear parallels between the descriptions of bodily manifestations
of internal sorrow or states in Troilus and Criseyde and the symptoms of leprosy in
Henryson’s poem.9 Thus, whilst Criseyde is presented in Troilus in terms of a remote,
8
Troilus’s attempts to hide the fact that he is lovesick appear to be connected to the
uncertain status of Criseyde within Troy: she is a widow whose father, Calchas, has
deserted the city to side with the Greek army.
9
Julie Orlemanski proposes that the Testament enacts its own form of justice by
proffering leprosy as a truer sign of Cresseid’s falseness and corruption. She argues that,
whilst its moral lesson may be subject to subversion throughout the poem, the
Testament ultimately enacts ‘its own move to a different regime of narrative poetics’.
236
otherworldly beauty (‘So aungelik was hir natif beaute,/ That lik a thing inmortal semed
she’ (I.102-3)), it is indexed to her internal disposition and morality. When she is forced
to leave Troy and join her father at the Greek encampment, as part of an exchange
between both armies, Troilus asks her to elope with him. Her refusal is framed in terms
of her moral integrity:
‘And also thynketh on myn honeste,
That floureth yet, how foule I sholde it shende,
And with what filthe it spotted sholde be,
If in this forme I sholde with yow wende’ (IV, 1576-1579).
Criseyde is represented in terms of an alluring flower throughout the poem, but here her
physical beauty is allied to her honesty or moral integrity ‘that floureth yet’. The layered
imagery thus plays on the idea of smeared beauty, implicating Criseyde’s virtue and her
physical appearance with the spots of filth that she affirms would be the outcome of an
elopement. This, then, provides the moral template from which Henryson draws upon in
his focus on Cresseid’s spots and disfigurement resulting from the punitive onset of her
leprosy. Physical change and an unseemly complexion also characterises Criseyde’s last
private meeting with Troilus in Chaucer’s poem:
With broken vois, al hoors forshright, Criseyde
To Troilus thise ilke wordes seyde:
“O Jove, I deye, and mercy I beseche!
Help, Troilus!” And therwithal hire face
Upon his brest she leyde and loste speche […]
And thus she lith with hewes pale and grene,
See Orlemanski, ‘Desire and Defacement’, p.169. Although I agree that the generic
distinction between both poems relates to their different perspectives towards the
character and actions of Criesyde/Cresseid, I claim here that there is continuity between
lovesickness and leprosy in both poems.
237
That whilom fressh and fairest was to sene (IV, 1147-55).
The final couplet, contrasting Criseyde’s former floral-like beauty with her pale and
colourless hue, underlines her sudden and radical transformation.
Therefore, in the Testament, Cresseid’s punishment is to suffer a condition that
coordinates with the melancholic suffering she is understood to have instigated in the
previous narrative. The fear Criseyde expressed in Chaucer’s text of being morally
compromised is literalised in Henryson’s version through the presence of spots on her
diseased body, as well as her hoarseness and physical weakness. Lovesickness in
Chaucer’s text could carry over into leprosy in Henryson’s poem because both are
represented as carrying the propensity to manifest hidden emotions and (potentially)
immoral thoughts on the body. Both Chaucer and Henryson participate in a late
medieval poetics where medical language, particularly that describing sicknesses prone
to moral or metaphorical deployment, like leprosy and lovesickness, is mobilised to
trace the (problematic) relationship between behaviour or desire and the (purportedly)
legible body.
The translation of Troilus’s lovesickness into Cresseid’s punitive leprosy in
Henryson’s text (along with its unstable semantics) exemplifies the fluidity with which
leprosy is represented in late medieval English culture. It shows how it proves amenable
to the articulation and probing of the relationship between the body and moral actions or
thoughts. Late medieval texts often configure leprosy as a superlative disease: it is
incurable; its effects on the body are comprehensive and radically disfiguring; its
presumed contagiousness invokes fears relating to social intercourse. These qualities
together with its strong biblical resonances meant that it provided potent opportunities
238
for writers to ground or ‘flesh out’ moral imperatives, and to promote edifying
opportunities through consideration of the disfigured and ravaged body.
In this chapter, I argue that the fluidity that attended representations of leprosy
rendered it suitable as an exemplifier for a variety of moral and devotional perspectives
or practices. A central feature of this was the way that metaphorical appropriations of
the disease could navigate between the external, ailing body and the internal, invisible
soul. I claim that leprosy had multiple uses across different genres and cultural modes,
and I question critical perspectives that seek to bracket it within specific and rigid
vectors: thus, I challenge history of medicine perspectives that view medical
descriptions of leprosy as fundamentally different to its religious and literary
articulations; but I also contest views by literary critics that place an exclusive indexical
relationship between leprosy and sexual behaviour or disease. I argue that leprosy, a
condition that intertwined physical, moral, and devotional representative modes in the
later Middle Ages, carried multiple significations. Such an analysis can help inform our
ideas of the cultural imaginary surrounding leprosy in late medieval culture. As current
perspectives of medieval leprosy move beyond an earlier model, which posed it
exclusively in terms of social ostracism, and insist upon a more dynamic, complex
perspective (described in more detail below), it remains important to consider how the
rhetoric of leprosy (as opposed to actual historic practices) navigated between ideas and
images of devotional incorporation and moral or physical distance.
239
Understandings and Management of Leprosy
The status of leprosy as a metaphorical category is entrenched in modern day
conceptions of the term. One of the OED’s definitions for ‘leper’ is that of ‘a person to
be shunned; a reviled or repulsive person; an outcast’ (the most recent example it cites
is the inclusion of the epithet ‘social leper’ in Bloodspell, a 2011 vampire novel).10 The
word retains associations that hearken back to a nineteenth-century medievalism that
conceived of the medieval leper as a figure comprehensively banished to the margins of
society.11 These connections were accented by the legacy of the term leprosy and its
conflation with skin ailments. A number of Middle English words were used to refer to
the disease: ‘lepre’ and ‘mesel’ regularly appear in writings, as does ‘lazer’, which
denotes the leprous subject as well as a leper hospital.12. However, the employment of
10
‘leper, n.2 and adj.’ (2), OED,
http://www.oed.com.ezproxy.lib.bbk.ac.uk/view/Entry/107372?rskey=Ipxn1G&result=2
&isAdvanced=false [accessed 11 December 2014].
11
Many nineteenth-century writers perpetuated fantasies of the segregated medieval
leper often to justify colonialist programmes of segregation. See David Arnold,
‘Introduction: Disease, Medicine and Empire’, in Imperialism Medicine and Indigenous
Societies, ed. by David Arnold (Manchester: Manchester University Press, 1988), pp.126.
12
These terms are largely interchangeable: whilst medical writings tend to use ‘leper’
(‘elefancie’ to refer to the most severe cases and, sometimes, ‘mesel’ to refer to nonleprous skin conditions), religious writings, romances and chronicles employ all three.
‘Lazer’ is an abbreviation of a composite Lazarus-figure made up of the leprous beggar
in Christ’s parable ‘Dives and Lazarus’ in Luke 16:13-91 and the Lazarus whom Christ
240
the Latin word lepra (originating in the Greek λέπρα) to denote the disease was itself the
inheritance of a confused scriptural legacy. It was a translation of the Hebrew word
sara’ath, signifying various skin conditions, which in Leviticus were defined as
unclean, though not particularly egregious, and were subject to injunctions including
periods of social exclusion.13 Lepra was differentiated in classical medical writings
from a more serious condition called elephantiasis, which was associated with a number
of symptoms including bodily deformity, disintegration of body parts, swelling, hair
loss and skin lesions. When scholastic medical writings were being translated from
Arabic into Latin in the twelfth century, lepra (the skin condition) was applied to the
more serious condition outlined in those texts (denoted by the Arabic word judham, the
cognate of elephantiasis) and this became implicitly associated with the Levitical social
exclusions and spiritual uncleanness (elephantiasis was retained to denote a category of
leprosy).14 The shifting semantics constellating around the term informed its use in late
medieval writings, where it continued to be articulated in terms of revulsion and disgust,
and helped to render it particularly amenable to a variety of metaphorical and moral
uses.
This potency can also be seen through the term’s obstinacy in late medieval
culture despite the apparent demise of the medical condition. Whilst leprosy (as it is
raised from the dead in John 11:1-44. See Peter Richards, The Medieval Leper and his
Northern Heirs (Cambridge: D.S. Brewer, 1977), p.8.
13
For sara’ath and its ancient significations, see Annette Weissenrieder, Images of
Illness in the Gospel of Luke: Insights from Ancient Medical Texts (Tübingen: J.C.B.
Mohr, 2003), pp.133-8.
14
Rawcliffe, Leprosy, pp.72-4; Richards, Medieval Leper, p.9.
241
understood today) dates back to the ancient world, its spread throughout Europe seems
to have accelerated in the eleventh century peaking in the thirteenth century. 15
Historians believe that it receded from much of the continent over the fourteenth and
fifteenth centuries, and cite the evidence of diminishing numbers of leprosaria, or leper
hospitals, during this period.16 However, leprosy remained a mainstay of medical
writings and continued to exert ethical and metaphorical power through its persistent
invocation in late medieval English culture.
Indeed, as mentioned above, the symbolic power of leprosy to evoke marginality
and social ostracism endures today. Carole Rawcliffe has recently debunked myths
largely perpetuated by nineteenth-century doctors that medieval responses to leprosy
were characterised by a comprehensive and ritualistic banishment of lepers from
15
Christine M. Boeckl cites circumstantial evidence provided by W.M. Meyers and
C.H. Binford that the crusades contributed to a dramatic rise in leprosy cases in Europe,
but this theory remains inconclusive. See Boeckl, Images of Leprosy: Disease, Religion,
and Politics in European Art (Kirksville, MO: Truman State University Press, 2011),
p.5, and Binford and Meyers, ‘Leprosy’, in Pathology of Tropical and Extraordinary
Diseases, ed. by C.H. Binford and D.H. Connor (Washington DC: Armed Forces
Institute of Pathology, 1976), pp.205-25.
16
See Luke Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body
(Baltimore and London: John Hopkins University Press, 2009), pp.vii-ix; Rawcliffe,
Leprosy, pp.106-110. For discussion of theories explaining the decrease of leprosy in
the later Middle Ages, see Robert S. Gottfried, The Black Death: Natural and Human
Disaster in Medieval Europe (New York, Free Press, 1983), pp.14-5.
242
societies.17 Although many medieval laws commanded that lepers should be kept
separate from the healthy populaces of towns and villages, in practice this segregation
was never complete. The creation of leper hospitals in the eleventh century emerged
from a dual purpose to both provide care for lepers and to help prevent the spread of the
disease.18 However leper hospitals did not imprison their patients; the voluntary
seclusion of lepers was not much different from those in monastic orders or charitable
foundations.19 Conversely, many healthy people attempted, and often succeeded, in
establishing residencies in these hospitals sharing in the ‘generous endowments which
founders provided for inmates’.20
The typical location of leper hospitals outside the gates of towns has also helped
fuel claims of sequestration.21 But this choice of location was typically based on a
mixture of quotidian and spiritual requirements: these institutions needed space as well
17
Rawcliffe, Leprosy, pp.13-43.
18
Orme and Webster, The English Hospital, p.23. For information of English leper
houses in the Middle Ages, see Marcia Kupfer, The Art of Healing (University Park,
PA: Pennsylvania State University Press, 2003), pp.142-4; Bernard Hamilton, The
Leper King and his Heirs (Cambridge and New York: Cambridge University Press,
2000), pp.154-5; A.E.M. Satchell, ‘The Emergence of Leper-Houses in Medieval
England’ (Unpublished doctoral thesis, University of Oxford, 1998); Kealey, Medieval
Medicus, pp.107-16.
19
Rawcliffe, Leprosy, pp.252-5 and 263.
20
Orme and Webster, The English Hospital, p.29.
21
See, for example, Frederick F. Cartwright, A Social History of Medicine (London:
Longman, 1977) p.27.
243
as access to water and to roads.22 The choice to build a hospital in a rural district might
also have been in imitation of the seclusion of the desert fathers.23 The close proximity
of leper houses and bridges also had spiritual and physical significance: the leprosarium
was often conceived of as offering a spiritual bridge that guided the sufferer through her
purgatory-like illness, whilst the gatehouses and bridges provided shelter for those
begging for alms and they afforded opportunities for begging as travellers crossed
them.24 Although lepers were often very close to the rest of the population, hospital
cartularies often included strict rules for insuring that inmates did not wander about the
countryside without leave (notwithstanding their voluntary status).25 Such documents
show that those in late medieval leper hospitals, like monastics, lived according to
religious rules; this included reciting the divine office, silence, liturgy and following a
strict dietary regimen.26 Cartularies drawn up for the hospitals, often on the basis of the
Augustinian Rule, tended to emphasize features such as obedience to a master, dress,
prayer, diet and chastity, although they were subject to variation from place to place.27
Inmates had to be single or, if married, their husband or wife had to be willing to live a
life of chastity. As with hospitals more generally, the spiritual framework guiding
leprosaria indicates that care of the soul was a major function in such institutions.
22
On the importance of clean water, see David Marcombe, Leper Knights: The Order of
St. Lazarus of Jerusalem in England, 1150-1544 (Woodbridge: Boydell Press, 2003),
pp.138 and 179.
23
Rawcliffe, Leprosy, pp.307-8.
24
Rawcliffe, Leprosy, p.311.
25
This is discussed in more detail in the final section of this chapter.
26
Kealey, Medieval Medicus, pp.110-12.
27
Brody, Disease of the Soul, p.76.
244
Nonetheless, although leprosy was understood to be incurable, some hospitals did
provide palliative care in the form of herbs, plasters and ointments, phlebotomy and
bathing. These were thought to provide help from the worst effects of the disease.28
Categorising Disgust: Medical Views of Leprosy
The mixture of medical and spiritual care provided for in leprosaria would suggest that
leprosy was understood generally in terms of a blending of these features in late
medieval culture. However, medical historian Luke Demaitre argues that the focus by
scholastic medical authors on the ternary system of ‘signs, causes, and cures’, and their
application of such a model to leprosy, set physicians apart from those literary and
religious writers who framed it in terms of ‘metaphor and moralisations’.29 However,
although descriptions of leprosy in medical texts tend to follow a rigid taxonomic
framework, its superlative features are conveyed through recourse to rhetorical excess.
In John Trevisa’s translation of Bartholomaeus Anglicus’s De proprietatibus rerum, the
conventional medical taxonomy of leprosy types is outlined metaphorically:
On maner lepra comeþ of pure malancolye and hatte elephancia, and haþ þat
name of þe elephaunt þat is a ful grete best and huge, for þis euel greueþ and
noyeþ þe pacient passinge hugeliche and sore. Þerfore þis euel is more harde and
fast, and wors to hele þan oþir.30
28
The level of physical care provided in an institution depended on the comparative
wealth of individual hospitals. Those that received sufficient endowments had a garden
where food and herbs were grown as well as other materials such as candles and wool
for clothing. See Rawcliffe, Leprosy, pp.304-5.
29
Demaitre, Leprosy in Premodern Medicine, p.vii.
30
Bartholomaeus Anglicus, Properties of Things, p.423.
245
Bartholomaeus goes on to describe the next category, ‘leonine’, in similar terms
referring to the lion’s fierceness as a descriptor of the effect of this type of leprosy on
the body. 31 The recourse to metaphor in this description is thus meant to convey the
superlative, overwhelming effects of the disease.
In a similar vein, Guy de Chauliac calls leprosy the ‘raþest’, or most principal, of
diseases.32 He describes its symptoms noting its ‘foule coloure, morphe, scabbe and
stinkynge filþes’, and he goes on to include deformed lips, writhing nostrils, stinking
breath, and hoarseness.33 The variety of symptoms that constellate around the condition
present problems of definition, particularly as only a few are required to be present in
order to effect a diagnosis. Furthermore, the focus on ulcerated or festering skin with
adjectives underlining disgust – ‘foule’, ‘stinkynge’ – signals profound unease towards
a condition characterised by the disintegration of bodily integrity, particularly where the
skin breaks to reveal its fleshly underside. Such apprehensions may have informed
worries about contagion that circulated around leprosy: Guy, in line with conventional
medical views, cites the causes of leprosy, in very general terms, as the result of
contagion through air or through contact with lepers, the effect of a poor diet, and
31
Bartholomaeus Anglicus, Properties of Things, p.424.
32
Guy de Chauliac, Cyrurgie, p.378.
33
Guy de Chauliac, Cyrurgie, pp 379-380. ‘Morphe’ signifies scurfy eruptions.
246
hereditary deficiencies.34 The excessive nature of the disease encourages him to again
employ metaphor in detailing its nature:
It is an evel compleccioun, colde and drye, even and dyuerse, in partie and in all
[…]. It is rottynge of þe schappe […]. It is cleped lepra, þe lepre, a lepore nasi (i.
of þe coppe and of þe nose), for þe tokenes þerof apperen þerynne raþest and
moste verraily. Or it is saide of þe worde lupus, a wolfe, for it devoureþ alle þe
membres as a wolf doth. It roteth forsoþe alle þe membres as a cancrouse wolf
[…]. And þerfore it is cleped of Avicen a commune cancre to all þe body.35
There is a curious mix of order and decomposition here as Guy’s careful and extensive
definition and categorisation of the disease rubs against his description of the bodily
disintegration it engenders. His use of the adjective ‘evel’ connects a diseased or
deformed condition with a malevolent or sinful one. He goes on to outline the disease
as distinctive through the way it can attack both each and all bodily organs and because
it disfigures the outline, or ‘schappe’ of the body.
The sense of proliferation and escalation of leprosy is paralleled by the variety of
names for the disease. Guy’s etymology for lepra is based on the proximity of the Latin
word for hare, lepus, with lepra; this prompts a connection between the hare’s nose,
‘lepore nasi’, and the disfigured nose of the sufferer where, he claims, leprosy can
appear soonest. He continues in this etymological vein citing the metaphorical
association between the wolf, lupus, and the effects of leprosy – ‘for it devoureþ alle þe
membres as a cancrouse wolf’.The evenness of the metaphor here - the comparison of
34
Guy de Chauliac, Cyrurgie, pp.378-9; Batholomaeus Anglicus, Properties of Things,
p.426. Guy de Chauliac advises that, in advanced cases, lepers should be withdrawn
from society and placed in a leper hospital. See Guy de Chauliac, Cyrurgie p.383.
35
Guy de Chauliac, Cyrurgie, p.378.
247
the disease’s ferocity and disintegrating effects with the wolf’s quality of devouring its
prey – collapses into a description of the wolf itself as ‘cancrouse’. I have identified this
type of metaphorical conflation as a persistent feature attending the interactions of
medical and moral registers elsewhere in this work; here, it suggests an over-stretching
of rhetorical language in the effort to convey a sense of leprosy’s annihilatory qualities.
Likewise, when Guy, quoting Avicenna, refers to leprosy as a ‘commune cancre’, it is
unclear whether he is developing the cancerous-wolf metaphor or classifying leprosy as
a cancer itself (normally defined in medieval medicine as a spreading ulcer or swelling).
The sliding between leprosy and other illnesses is repeated when Guy discusses
the development of leprosy in the body: ‘And þe wiþholdynge of melancoliouse filþes
fastene þise togidre, as þe filþes of þe emoroydes, of þe menstrues, of varioles, of
quartaynes, and feblenesse of þe mylte and hete of þe lyuer’.36 The concept of leprosy
seems to resist attempts to define and describe it because its protean features encourage
conflation with other conditions. Its rhetorical representation in Guy’s text shows how it
mitigates the bodily integrity of the sufferer and subsumes other diseases.
Guy’s description of leprosy reveals how, even in writings that are oriented
towards descriptive and taxonomic modes, leprosy could be prone to highly figurative
renderings. Demaitre does acknowledge that popular associations between leprosy and
evil may have been bolstered by those same associations advanced by authors like Guy
de Chauliac.37 Yet, he argues, these were instances where medical language was
infiltrated by other discursive strands, where ‘notions of impurity and judgement tainted
36
Guy de Chauliac, Cyrurgie, pp.378-9. ‘Melancoliouse filþes’ refer, in this case, to
purulent matter.
37
Demaitre, Leprosy in Premodern Medicine, pp.80-1.
248
some discussions of causes and consequences’.38 However, there is no ‘untainted’
medical language that exists outside of its articulations in such writings, and any
attempt to extrapolate value-neutral language from these definitions and descriptions of
leprosy is to risk inflecting a text like Guy’s treatise through the anachronism of a
modern, (putatively) objective medical discourse. The above analysis of the description
of leprosy provides an example of how late medieval medical writings are wholly
invested in configuring leprosy in ideological ways. It signals how, when religious
authors turned to scholastic medicine for a register through which they could develop
moral or metaphorical ideas of leprosy, they would have encountered one richly
resonant and exquisitely amenable to such an application.
Sin on Skin: Moral Leprosy
An early fifteenth-century anti-Lollard sermon, written in the vernacular by Hugo Legat
(fl. c.1399-1427), a monk and Benedictine prior at St. Albans, Hertfordshire, reveals the
incorporation of leprosy and its symptoms within didactic literature. It exemplifies the
diversity of moral conditions that could be associated with the disease. In one of his
sermons, Legat develops the trope of leprosy as a figure for a host of sins. He begins by
referring to Christ’s healing ministry and focuses on the account in Luke 17:12-14 of
his healing of ten lepers. Legat goes on to link exegetically the lepers in this account to
‘al maner o volk þat liggen her e þis world e þe siknes & te sorw of dedli synne’.39 The
employment of leprosy as a means to imagine sin is enabled by the legibility of diseased
38
Demaitre, Leprosy in Premodern Medicine, pp.91.
39
Hugo Legat, Three Middle English Sermons from the Worcester Chapter Manuscript
F.10, ed. by D.M. Grisdale (Kendal: University of Leeds, 1939), p.29.
249
skin: ‘ȝif þe be e þe scabbe, e þe lepur o dedli synne, þe art more vowler & mor horrible
e þe sith o God þanne euer was any mesel þat euer was maad her be-fore’.40 Legat’s
reference to ‘scabbe’ is instructive here: the term was used in Middle English to refer to
any one of a variety of skin diseases and signified, more generally, blotchy or ulcerated
skin. It was often mentioned as a prominent characteristic of leprosy (as it is in Guy de
Chauliac’s treatise), and the conflation between both in Legat’s text is another example
of the overlapping of leprosy with other ailments.41 The visual force of the metaphor he
uses depends, first, on its evocation of the disgust the reader or hearer is expected to
experience on beholding leprous skin and, second, on this disgust being a shadow of the
revulsion God feels on beholding the sinner’s soul. Leprosy thus offers a productive
means of materialising Christian views of the effects of sin on the soul.
The disgust that leprosy engenders is yoked to the idea of skin as offering a
medical hermeneutics of the body. Legat develops the metaphor to visualise skin as a
screen on which sins are revealed as leprous sores. He composes a prayer, which he
advises his hearer to recite: ‘“Lord God, take hede”, þe schalt seye, “to me sowle & behold how vowl it is be-spottid with þe lepur in-to þe scabbe of synne & deliuere it from
al þe vilþe & vnclennes þat is trine”’.42 The medical model of the marks and ‘spots’ of
leprosy as outward signs of effects taking place within the body is paralleled here in the
idea of the soul having a skin, or some kind of surface, where spots, or the ‘scabbe’, are
visible to the privileged sight of God, indicating the penitent’s internal condition of
40
Legat, Three Middle English Sermons, p.29.
41
‘scab(be. n’, MED http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED38677 [accessed 11 December 2014].
42
Legat, Three Middle English Sermons, p.29.
250
‘vilþe & vnclennes’. Just as the physician can read diseased skin and diagnose a
condition such as leprosy, God can see the ‘scabbe of synne’, know its internal
condition and, through forgiveness, effect the sinner’s deliverance.
Legat goes on to outline a classificatory framework where the principal effects of
leprosy are associated with particular sins. In one, he links leprosy’s ability to bring
about physical deformities with the effects of gluttony on the body: both, he says, can
efface beauty. He cites an exemplum from the Policraticus of John of Salisbury (11201180) that tells the story of Dionysius, King of Sicily, ‘as fair of face, as bewtewus o
bodi & as lusti vor to loke vpon, as any man’, who falls sick as a result of leading a
gluttonous lifestyle.43 In relating this, Legat enacts again the typical moral-medical
rhetorical strategy of moving from the invocation of disease as an image of sin to the
idea that it is the effect of sin:
But afterwarde, whan a ȝaf hym to lustis & likyngis of his flesch, to delices o mete
& drynk & to mysrule þat sueþ þer-of, a-non rith a lost al þe flowres of his fairhede, al þe helþe of his body, & in-to gret siknes & strong disese & a-mong al
oþer, a lost þe sithte o boþe his eȝen. […] And ter-vro vor Cristis sake, be-war o
þis vis & tis synne & specialiche e þis holi tyme o lente.44
The sicknesses that Dionysius suffers from are constituted here as the causal effects of
his lifestyle, yet they are intrinsically linked to the hearer’s moral behaviour as
evidenced in the author’s appeal to observe abstinence in Lent.45 They also encompass
social disease in the form of Dionysius’s misrule of his kingdom. Legat goes on to
43
Legat, Three Middle English Sermons, p.30.
44
Legat, Three Middle English Sermons, p.30.
45
The exemplum can be connected, in this sense, with late medieval health regimens
(discussed above in the introduction to this thesis).
251
mention the specific illnesses that can result from gluttony including gout and dropsy
before describing it again in terms of spiritual leprosy: ‘Vor þer is no lepur e þe world
þat semyþ so vowl & so orrible in owr sichte, as doþ a glotun e þe siþte of God’.46
Therefore, within the ordering metaphor of leprosy, we find a proliferation of other
physical illnesses and spiritual sicknesses, linking gluttony and political ineptitude.
Legat locates in leprosy similar generative qualities as Henryson does: leprous
skin is indexed to sin and moral failure; the disgust it engenders can be employed to
promote edification. Whereas physical beauty is posed in contrast to the disfigurements
of leprosy, it is implicated in its onset through its arousal of sexual desire (as evident in
the figures of Cresseid and Dionysius). Whilst the link between sexual excess as both a
cause and a symptom of leprosy is one that was made by late medieval moralists and
medical writers, its importance tends to be exaggerated by modern critics. Sexual
behaviour was just one of the many associations that cleaved to leprosy. The fluidity
with which leprosy is presented in Legat’s text, both in terms of its physical
manifestations and the variety of its moral indices, provides a corrective to views that
would place an exclusive correspondence between leprosy and sexual behaviour in
medieval culture and reveals how it operated in much more subtle and multifarious
ways.47
46
47
Legat, Three Middle English Sermons, p.31.
Derek Pearsall, for instance, argues that the tracing of moral qualities in physical
degradation in Henryson’s Testament is underlined by the association between leprosy
and sexual disease in the later Middle Ages. See Pearsall, ‘Henryson’s Testament’,
p.176. Similarly Jonathan Hsy argues that ‘leprosy comprises an overt symptom (or
consequence) of a range of sexual sins including lechery, adultery and sodomy’. Hsy,
252
Intimacy and Estrangement: Devotion and Leprosy
The fluctuating nature of leprosy, as evinced in the metaphorical treatments of the
condition described above, resonates with a late medieval pietistic tradition of
advancing it as a means of devotional access. Yet, whereas, in Legat’s and Henryson’s
configurations, leprosy provides a means of mapping the soul onto the diseased body,
the affective tradition locates edifying opportunities and divine access through the
associations triggered by encounters with the leprous body (although both moral and
affective modes can often be mutually present in a narrative). The bases of such
material can be traced to accounts of Christ’s healing of lepers in the New Testament
and to his commandment to treat the sick and poor as if they were Christ.48 Whilst
Legat’s leprosy metaphors insist upon the soteriological need to overcome or maintain
distance from the sin-infested soul, affective narratives articulate desire for a
contemplative or tactile relationship with lepers in order either to imitate Christ or view
lepers as Christ-like.
Indeed, there was a late medieval pietistic tradition of articulating leprosy and its
symptoms in descriptions of Christ’s sufferings in the Passion. Devotional authors,
following the Vulgate Bible’s translation of Isaiah and its description of the man of
‘“Be more strange and bold”: Kissing Lepers and Female Same-Sex Desire in The Book
of Margery Kempe’, Early Modern Women: An Interdisciplinary Journal, 5 (2010),
189-99 (p.190). On medieval medical links between leprosy and venereal contagion, see
Jacquart and Thomasset, Sexuality and Medicine, pp.183-93.
48
These passages are respectively Luke 17:12-14 and Matthew 25:36-40.
253
sorrows, imagined a Christum quasi leprosus.49 Given the shifting ideas and
conceptions of leprosy in late medieval culture, the idea of Christ being ‘like a leper’ is
not so much an appeal to a definable signifier, but rather an extension of the unstable
semantics constellating around the figure of the leper. In one sense, it appeals to the
very formlessness that the term ‘leprosy’ evokes; in another it refers to the social
marginalisation and humility that accompanies the identification of a person as a leper.50
Both features are present in a meditation on the Passion ascribed to the Yorkshire
hermit and mystic, Richard Rolle. Rolle presents the events of the Passion from the
perspective of Christ, as a means to engage directly the reader’s affective empathy:51
And after Iudas had salde me: þe Iues toke me, & buffet me & spittid in mi face;
with scharpe thornis þai coronid me, with knottid scourgis þai dang me; so laitheli
þai dight me: þat i was like a mesell til loke on.52
49
‘Surely he hath borne our infirmities and carried our sorrows: and we have thought
him as it were a leper, and as one struck by God and afflicted [nos putavimus eum quasi
leprosum et percussum a Deo et humiliatum]’, in DR, Isaiah 53:4.
50
See Julie Orlemanski, ‘How to Kiss a Leper’, postmedieval: a journal of medieval
cultural studies, 3 (2012), 142–157 (p.149).
51
For the debate on the authorship of this text, see Rosamund S. Allen, ‘Meditations on
the Passion’, in Richard Rolle: The English Writings, ed. by Rosamund S. Allen (New
Jersey: Paulist Press, 1988) pp.90-1.
52
Richard Rolle, ‘Meditation on the Passion; and of Three Arrows on Doomsday’, in
Yorkshire Writers: Richard Rolle of Hampole: An English Father of the Church and his
Followers, ed. by Carl Horstman, Vol. I. (London: Swan Sonnenschein, 1895), pp.11221 (p.119). See also London, BL Arundel MS 507, f.44.
254
Just as medical descriptions of leprosy emphasise its distinctive nature through the
listing of excessive symptoms, the resemblance of Christ to a leper, in this passage,
depends upon the accumulation of the various tortures he endures. The succession of
verbs – ‘buffet’, ‘spitted’, ‘coronid’, ‘dang’, ‘dight’ – invites the reader to imagine the
diverse tortures Christ is afflicted with. These coalesce to produce an integral image
through which one can visualise Christ’s sufferings and abjection in the Passion. Given
the late medieval reduction of instances of leprosy, it is likely that such an image
derived its potency more through associations of excess and disgust with the term
‘leper’, than through readers’ quotidian experiences of confronting people with the
disease. There is a corresponding categorical relationship between lepers and Jews in
this passage in that both were subject to the attentions of devotional writers and
employed as caricatures of otherness to instigate and inform exercises of piety.53 In
Rolle’s account, the reader’s devotion is meant to be stimulated through remembrance
of the excessive tortures enacted upon Christ (and their mutilating effect on his body) as
well as of his social abjection: the figure of the leper conveys resonances of disgust and
exclusion, as well as of charity and pity, and therefore assumes a productive image
through which to represent the suffering Christ.
Such descriptions acquire devotional leverage through conveying a sense of
absolute bodily annihilation, and medical descriptions of the disease provide a register
suitable for this endeavour. Christ is again compared to a leper in the Liber Celestis of
53
On late medieval representations of Jews as a means of constituting Christian piety,
see Anthony Bale, Feeling Persecuted: Christians, Jews and Images of Violence in the
Middle Ages (London: Reaktion Books, 2010).
255
the mystical writer, Bridget of Sweden (1303-1373), in an account that wavers between
his internal body and outward appearance:
Þan aperid his een halfe dede, his chekes fallen, his semblant heui, his mouth
open, his tounge blodi, his wombe cleueand to his bake, and all his humurs wasted
awai as if he had no entrals, and so all þe bodi left pale in languore for fluxe, in
pasinge of blod. […] And for he was of þe beste kinde, þarefore was þare a
stronnge fight in his bodi bitwene life and dede, for when þe paine fro þe vaines
or sinows or oþir partes went to þe herte þat was freshe and vncorrupt, it vexid it
and trauailed it with an vntrowabill sorowe and passion. And sometime þe sorowe
went fro þe hert vnto oþir partees and so proloined þe dede with grete bittirnes.54
Like medical descriptions of leprosy, there is an emphasis on facial disfigurement here
as Bridget discharges an anaphoric succession of images of mutilation. As the narrative
moves from the superficial to descriptions of Christ’s internal viscera, it slows to
accommodate the dense humoral language, charting the movement of blood and fluids
through the body. As much as Christ’s external wounds are described in terms of
excess, his internal body is conveyed through emptiness: his stomach clings to his back
and his humors are wasted away ‘as if he had no entrals’. The adoption of a medical
register here enables the intensification of Christ’s tortures by allowing the narrative
lens to move inside his body and detail the effects of the Passion. This is outlined in
terms of the infiltration of pain and sorrow, transmitted by nerves and blood vessels
from the bodily extremities, upon the ‘freshe and vncorrupt’ sacred heart, and thus
unleashing its own superlative ‘vntrowabill’, or unbelievable, passion. This decimating
sorrow, a subjective state that appears to take on its own substance inside the body,
travels to other body parts, destroying them, and thus extends Christ’s sufferings.
54
The Liber Celestis of St. Bridget of Sweden, ed. by Roger Ellis, EETS no. 29, Vol. I:
Text (Oxford: Published for the Early English Text Society by Early English Text,
1987), p.21.
256
This portrayal, in following a trajectory that begins with superficial physical
disfigurement and ends with the wholesale collapsing of internal organs, aligns with late
medieval medical descriptions of the progressive and overwhelming effects of leprosy
on the body. Accordingly, Bridget describes Christ’s aspect after his Deposition from
the cross with reference to the disease:
He had semed leprous and bloo, for his een were dede and full of blude, his
mouthe was cold as snowe, his face drawen togidir and contractid. His handes
were so starke, þai might noȝt be put forthir þan aboute þe nauill.55
Again, Bridget’s account lingers on the correspondences between Christ’s deathly
visage and conventional symptoms of leprosy: bloodshot eyes, skin discoloration, and
claw-like hands.56 Christ’s assumption of the attributes of leprosy after death also tallies
with contemporary representations of leprosy as a death-like condition.57
The qualifier that Christ ‘semed’ leprous, in this account and in all others that
adopt the trope, aligns Christ’s condition with that of a leper, but, in doing so, it marks a
distinction: Christ is not a leper, although his physical appearance and social
mortification makes him resemble one. Yet the protean qualities that attend
representations of leprosy in late medieval culture blur any clear demarcations between
a leprous and a ‘quasi’-leprous state. The inextricability of the idea of leprosy as a
55
St. Bridget of Sweden, Liber Celestis, p.22.
56
Rawcliffe, Leprosy, pp.61-3
57
For references of leprosy as a ‘living death’, see Bynum, Fragmentation and
Redemption, pp.136-7; Brody, Disease of the Soul, pp.66-7. I discuss the ‘symbolic
death’ of the leper as rendered in a sixteenth-century ‘separation ritual’ in the final
section of this chapter.
257
medical condition from the metaphors and rhetorical tropes that attend its articulations
in Middle English writings highlights its importance as a signifier of bodily and spiritual
fragmentation. The appellation of Christ as ‘like a leper’ is therefore not so much a
sharply-defined analogy promoting identification through ekphrasis; it is rather the
incorporation of valences pertaining to affective empathy, piety and spiritual perfection
(along with disgust, revulsion, and moral exemplification) within the term’s semantic
field. Leprosy is therefore as much a disease imbued with Christological significance as
it is one that elucidates categories of sin, or one which results from excessive
melancholy in the body.
The associations between leprosy and Christ inform late medieval accounts of
saintly charity or performances of mercy towards lepers. These accounts tend to be
grounded in the same dynamics that informs the Christum quasi leprosus meme,
hesitating between disgust and desire. Such a tension is evoked in a late fifteenthcentury stained glass panel of the Pietà in the Holy Trinity church in Long Melford,
Suffolk. The image depicts Christ with features bearing strong resemblances to images
and descriptions of leprosy such as Bridget’s account (Fig.13).58 The most striking
element of the image is Christ’s naked and rigid body enfolded within the Virgin’s
58
For information on this image and its production, see C. Woodforde, The Norwich
School of Glass Painting in the Fifteenth Century (London and Oxford: Oxford
University Press, 1950). On the patronage and gentry culture around Long Melford,
especially its Clopton chantry, see David Griffith, ‘A Newly Identified Verse Item by
John Lydgate at Holy Trinity Church, Long Melford, Suffolk’, Notes and Queries, 58
(2011), 364-7; J.B. Trapp, ‘Verses by Lydgate at Long Melford’, Review of English
Studies, 21 (1955), 1-11.
258
luxurious and ornamented robes. His torso is speckled with what appear to be the kind
of spots usually depicted on the bodies and faces of lepers as instant signifiers of the
condition; on closer inspection they are miniature wounds comprised of a horizontal
slash with emerging droplets of blood.
The dead Christ, bearing the signifiers of leprosy, is physically contrasted with his
mother as he is simultaneously shown to be the subject of her sorrow and care: her
fleshly face is in contrast to his emaciated torso that tapers downwards as it disappears
under her red mantle. Christ’s angular face with flattened nose, his intense stare and
clawed hands are strongly reminiscent of contemporary medical descriptions of
leprosy.59 Yet the horror and pity that these features were designed to instigate can be
seen to be tempered by the image’s redemptive context, particularly as manifested in the
Virgin Mary who holds the dead Christ. The throne she sits upon, the sun rays
appearing behind her (enhanced by the actual light appearing through the Church’s
window at Long Melford) and the direction of her sorrowful gaze, which seems to
extend beyond Christ’s disfigured body, all work to foreshadow the resurrection. The
leprous body, then, provides a point of meditation for the fifteenth-century worshipper,
exemplifying not only the sorrows of the Passion but the wider soteriological context
that they generate, and are situated within.
The allocation of the sufferings and symptoms of leprosy within Christological
and soteriological contexts informed descriptions of the care provided by holy figures to
lepers. Such narratives are predicated upon their own kind of excess: they typically
59
This can be contrasted with the fact that most images of the pietà depict Christ with
his eyes closed; see Boeckl, Images of Leprosy, pp.68-9; Pearman, Women and
Disability, p.106.
259
feature the saint or holy person going far beyond the fulfilment of charitable requisites
to demonstrate their superlative abasement or humility when confronted by lepers. The
vita of St. Hugh (1140-1200), bishop of Lincoln, by his chaplain, Adam of Eynsham
(author of the Revelations of the Monk of Eynsham), describes how Hugh washed the
feet of lepers and affectionately kissed them before exhorting them to avoid wrongdoing.60 Adam makes much of the disgust he himself feels towards their swollen, livid
skin and their deformed features, and he contrasts this with Hugh’s privileged,
exemplary perspective of their ‘internal splendour’.61
60
Adam of Eynsham, Magna Vita Sancti Hugonis: The Life of St. Hugh of Lincoln, Vol
I, ed. by Decima L. Douie and David Hugh Farmer (Oxford: Clarendon Press, 1985),
p.13.
61
Adam of Eynsham, Life of St. Hugh, pp.13-14. A fifteenth-century Middle English
exemplum, translated from the collection of exempla, the Alphabetum narrationum by
the French preacher, Etienne de Besançon (d.1294), turns on a similar worldly-spiritual
dynamic in its tale of how a leper asks a charitable man to wipe his nose. The leper,
complaining that the man’s fingers are aggravating his sores, asks him to continue by
licking his nose instead; on obliging him, the man instantly finds that two precious
stones have been dropped into his mouth. The tale works by foregrounding disgust as a
means to insist upon the holy man’s otherworldly charity and the spiritual rewards this
brings about. See Alphabet of Tales: An English 15th Century Translation of the
Alphabetum Narrationum of Etienne de Besançon, ed. by Mary MacLeod Banks, EETS
o.s. no.126-7 (London: Published for Early English Text Society by Kegan Paul,
Trench, Trübner, and Co., Ltd, 1904, 1905), p.302. For other accounts of saints
affectively caring for lepers, see Peyroux, ‘The Leper’s Kiss’, pp.172-88.
260
The Book of Margery Kempe invokes leprosy according to a similar affective
economy. Margery encounters lepers in the street at her hometown of Lynn and their
presence reminds her of Christ’s sufferings:
Sche myth not duryn to beheldyn a laȝer er an-oþer seke man, specialy ȝyf he had
any wowndys aperyng on hym. So sche cryid & so sche wept as ȝyf sche had sen
owr Lord Ihesu Crist wyth hys wowndys bledyng […]. For thorw þe beheldyng of
þe seke man hir mende was al takyn in-to owr Lord Ihesu Crist.62
The passage makes clear the lepers’ role as a channel through which Margery’s mind
can become suffused with contemplation of Christ (similar to the ‘bare life’ status of
Elizabeth of Hungary’s charges, described in the previous chapter). The employment of
the verb ‘beheldyn’ is important in this sense because it links sight with touch and
suggests that the tableau of the lepers exerts a psychosomatic effect on Margery,
prompting her to become ‘al takyn’ into Jesus. If such a description resounds with fears
of physical contact and transmission that sometimes constellated around the subject of
leprosy, it enacts a reversal through proffering Margery as an exemplary figure who can
transform leprous touching from a threatening gesture into a devotional event. Likewise,
the lepers’ wounds are divested of their repulsive character and become sites of
devotional expediency, generating a vision of the bleeding Christ.
Leprosy, in the Book of Margery Kempe, thus becomes an index of Margery’s
saintliness: she desires to interact with lepers because they provide her with a chance to
perform works of mercy, and because their sores or ‘wowndys’ allow access, through
62
Kempe, Book of Margery Kempe, p.176.
261
resemblance, to the image of the suffering Christ.63 This is in accordance with other
instances where Margery seeks to emulate the lives and actions of Christ and the Saints,
and forms, in this way, part of Kempe’s ‘calculated hagiographical’ enterprise.64
Margery’s desire to touch and kiss the lepers expresses a similar rhetoric to that outlined
in St. Hugh’s hagiography.
Although disgust is a feature of Margery’s encounters with lepers (we are told
that, prior to her relationship with Christ, they had seemed ‘lothful’ and ‘abhomynabyl’
to her),65 the narrative does not dwell, like other accounts such as that of St. Hugh, on
summoning the reader’s disgust through visceral accounts of the fragmented and
formless bodies. This elision appears to be based on the ability of the term ‘laȝer’ or
‘leper’ to carry such connotations. The function of leprosy to illustrate otherworldly
sanctity would certainly be a familiar one to readers of hagiographies and pious works
by the fifteenth century. Likewise, when the Book describes Margery’s desire to kiss the
lepers (‘than had sche gret mornyng & sorwyng for sche myth not kyssyn þe laȝerys
whan sche sey hem er met wyth hem in þe stretys for þe lofe of Ihesu’), it invokes
another well-established hagiographical theme.
63
Again, this is the same dynamic that informs the merciful works for the sick and poor
undertaken by saints like Elizabeth of Hungary.
64
Gibson, Theater of Devotion, p.47. For more discussion of the hagiographical
purposes in the Book, see Lynn Staley, Margery Kempe’s Dissenting Fictions
(Philadelphia: Pennsylvania State University Press, 1994), and Katherine J. Lewis,
‘Margery Kempe and Saint Making in Later Medieval England’, in A Companion to the
Book of Margery Kempe, ed. by Arnold and Lewis, pp.113-28.
65
Kempe, Book of Margery Kempe, p.176.
262
Although Margery is forbidden by her confessor to kiss the lepers on Lynn’s
streets (because they are male), she is allowed to go to ‘a place wher seke women
dwellyd’.66 She meets and embraces two female lepers and, like St. Hugh of Lincoln,
exhorts the women to accept their illness with patience and meekness. One of the
women, a virgin, responds:67
Þan þe oo woman had so many temptacyons þat sche wist not how sche myth best
be gouernyd […]. And sche was labowryd wyth many fowle & horibyl thowtys,
many mo þan sche cowde tellyn.68
Jonathan Hsy proposes that ‘as much as this passage intimates lechery, its evasive prose
style also evokes the discursive specter of sodomy’; in the way it ‘gathers together any
number of non-heteronormative acts and desires’.69 Noting how sodomy is often
invoked through non-specification, Hsy suggests that ‘this episode […] leaves open the
possibility that such performances could invite illicit desires between women’ (original
emphasis).70 Yet whatever the extent to which the leper’s secretive thoughts might
66
Kempe, Book of Margery Kempe, p.177.
67
On the possible significance of the leper’s virginity in the context of the wider text,
see Rossalynn Voaden, ‘Beholding Men’s Members: The Sexualizing of Transgression'
in The Book of Margery Kempe’, in Medieval Theology and the Natural Body, ed. by
Peter Biller and A.J. Minnis (York: York Medieval Press, 1997), pp.175-90 (p.183).
68
Kempe, Book of Margery Kempe, p.177.
69
Jonathan Hsy, ‘Kissing Lepers’, p.192. On deviant sexuality in the description of
Margery’s care for lepers, see also Pearman, Women and Disability, p.142.
70
Hsy, ‘Kissing Lepers’, p.192. Hsy develops Kathy Lavezzo’s suggestion of the homo-
erotic dimensions of Margery’s performances of affective piety in the Book. See
263
index sexual desires, what is insisted upon in this passage is their multifarious and
unbounded significations: her ‘many fowle & horibyl thowtys’ are amplified to ‘many
mo þan sche cowde tellyn’ (emphasis added). The Book implies that the proliferation of
such thoughts and/or their appalling nature means that they are rendered
uncommunicable. The association of ‘fowle and horibyl thowtys’ with leprosy recalls
the overlap between the physical disease and the condition of the soul in Hugh Legat’s
sermons and Henryson’s Testament (it also echoes Guy de Chauliac’s claim that leprosy
makes a person look ‘horrible in þe maner of a beste’).71 The hazy and imprecise nature
of the disease in late medieval culture allows it to stand as a figure, not for one set of
sexual sins, but for a wide variety of illicit behaviours and emotions. In the leper’s
confession to Margery, the admission of her foul and ungoverned emotions would
signal, for the reader, a multiplicity of vague and monstrous desires, saddled to the
formless and egregious features attending articulations of leprosy.
The intertwining of leprosy with internal moral states in this passage marks a shift
as the register moves away from an affective, empathetic, and saintly identification with
lepers (or with their representative status as metonyms for the suffering Christ) to one
that sees their deformities and blemishes as manifestations of their internal state. The
intimacy and identification that attends the affective model is replaced by one insisting
on distance and estrangement similar to that incorporated by Legat in his prayer
encouraging the penitent to conceive his soul as leprous skin.
Lavezzo, ‘Sobs and Sighs between Women: The Homoerotics of Compassion in The
Book of Margery Kempe’, in Premodern Sexualities, ed. by Louise Fradenburg and
Carla Freccero, pp.175–98.
71
Guy de Chauliac, Cyrurgie, p.380.
264
Indeed, the sense of productive self-alienation in the leper’s confession is echoed
by the annotation of one of the Book’s late medieval readers. The single manuscript of
the Book owned by the Carthusian Monastery Mount Grace in Yorkshire in the midfifteenth century (London, BL Add MS 61823) is annotated by four different hands
dating from this period. One annotator has inscribed in red ink on the margin beside the
leper’s confession, ‘A sotel & a sore temptacion. In siche a case we shold be more
strange & bold a-ga[n]ste our gostly enmy’.72 The mention of ‘sore’, hinging between
painful or ulcerated skin and emotional anguish, suggests that the annotator participates
in the same overlapping rhetoric that the main text asserts (it also resonates with the
‘sorowe’ that is invested with material form in Bridget of Sweden’s text). The
knowledgeable tone of the annotation implies that he holds a specific insight into what
the temptations are, and this would suggest that the note is an interpretation of the sins
acknowledged by the leper in the text; but the refusal to qualify it signals again that the
annotator is sharing in the semantic uncertainties that the Book’s passage promotes.
Likewise, the unqualified reference to ‘our gostly enmy’ repeats this sense of
indeterminacy. The note intimates the edifying potency in the leper’s references to nonspecified temptations (inspiring the annotator to add a comment in the first place), as
well as the way that its nebulous framework of reference lends itself to repetition. The
annotator chooses instead to foreground the sense of self-alienation in the confession
72
London, BL Add MS 61823, f.86b. See Kempe, Book of Margery Kempe, p.177. For
an exploration of the annotations in the Book, see Kelly Parsons, ‘The Red Ink
Annotator of The Book of Margery Kempe and His Lay Audience’, in The Medieval
Professional Reader at Work: Evidence from Manuscripts of Chaucer, Langland,
Kempe and Gower, ed. by Kathryn Kerby-Fulton and Maidie Hilmo (Victoria:
University of Victoria, 2001), pp.143-216.
265
and develops the leper’s admission of labouring under her unwanted thoughts by
advocating that we be ‘strange’ against them. The word connotes being aloof or
unfriendly, as well as being alienated from one’s own nature.73 It could also refer, in a
medical sense, to extraneous or improper things or qualities within the body.74 From this
perspective, the ‘gostly’ temptations and leprosy (as both symbol and effect of a host of
morally dissolute actions and thoughts) are linked in the way that they both inhabit the
body, and because they are implicated in a poetics that requires the cultivation of
estrangement towards one’s own body and soul. The leper’s speech to Margery in the
Book, then, overlays a confessional discourse, emerging out of the condition of leprosy
and its moral resonances, upon a one based on edification through a Christological
empathy with leprous bodies.
73
‘straunge, adj.’, MED, http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED43218/ [accessed 11 December 2014]. Jonathan Hsy also
connects ‘strange’ with courtly love traditions and the self-regulation of the lady’s
behaviour in the face of the knight’s advances. See Hsy, ‘Kissing Lepers’, p.193.
74
Guy de Chauliac, for example, describes transmutation as ‘made of straunge hete in
putrefactible materie’. See Guy de Chauliac, Cyrurgie, p.169.
266
Fig.13: Pietà. Stained Glass Panel. 1450-1500. Long Melford Church, Suffolk
(reproduced by permission of the Rector of Holy Trinity Church, Long Melford).
Performing Contagion
The implication of danger that wafts about the wounded lepers in Lynn’s streets
conveys apprehensions of their unregulated spatial movement and opportunities of
social interaction. Margery reveals to her confessor the abundant devotional desire that
seeing the lepers has inspired:
267
Than sche teld hir confessowr how gret desyre sche had to kyssyn laȝerys, & he
warnyd hir þat sche xulde kyssyn no men, but, ȝyf sche wolde al-gatys kyssyn,
sche xuld kyssyn women. Þan was sche glad, for sche had leue to kyssyn þe seke
women & went to a place wher seke women dwellyd [italics added].75
The mention of a ‘place’ where Margery goes to kiss the lepers suggests that her
confessor’s prohibition relates not just to the street lepers’ masculinity, but also to their
ungoverned status appearing as they do outside the confines of the institution.76 The
confessor’s implicit concern that Margery’s devotional energies may be translated into
(or read as) morally illicit behaviour relates to late medieval moral and physical
concerns about the public presence of lepers and their interaction with the wider
community. As mentioned above, whilst such concerns did not mean that lepers were
banished from public spaces, a substantial corpus of institutional regulations and official
writings is concerned with the careful management of lepers, within and without,
institutions. This is not to say that such administration was replicated in actual practices,
but rather to emphasise the textual construction of the leper in terms of both fears of
contagion and the semantics of the diseased or deformed body. There was an intrinsic
connection between leprosy and contagion in the Middle Ages given that it was
75
Kempe, Book of Margery Kempe, p.177.
76
There was a leper house at Gaywood, close to Lynn, in the fifteenth century known as
St. Mary Magdalene’s. See P.H. Cullum, ‘“Yf lak of charyte be not ower
hynderawnce”: Margery Kempe, Lynn, and the Practice of the Spiritual and Bodily
Works of Mercy’, in A Companion to the Book of Margery Kempe, ed. by Arnold and
Lewis, pp.177-93 (p.180); David Knowles and R. Neville Haddock, Medieval Religious
Houses, p.367; Rotha Mary Clay, The Mediaeval Hospitals of England (London:
Methuen and Co., 1909), p.307.
268
believed to be easily communicated from person to person, but also via infectious air
and food.77 Nonetheless, just as medieval leprosy cannot be understood in exclusively
physical terms divested of its moral connotations, late medieval concerns regarding
leprosy’s contagiousness were wholly imbued with moral perspectives and language.
Margery Kempe’s visit to a leper-house and tactile engagement with its inmates
shows that, whatever the fears of moral and physical contagion congregating around
her confessor’s proscription against kissing lepers in the street, the same contagion does
not pertain to the hospital. The institutional setting appears to ward off contagion
through spatial configurations, proscriptions and its provision of devotional and moral
contexts. However, late medieval cartularies of English leprosaria and other official
records reveal a creative tension between the allowance of spatial freedom or social
intercourse and institutional or domestic confinement. Such sources indicate that
contagion can be mitigated by ritual and symbolic practices as much as spatial
confinement.
Ritual responses to leprosy are heavily invested in a document included in the
Sarum Missal, a text outlining a rite instituted by Osmund (d.1099), bishop of Salisbury,
which established liturgical order and its principle format in the south of England over
the high and later Middle Ages.78 The document describes the separation ritual for
77
It is estimated today by medical authorities that around 95% of people have immunity
to leprosy although much debate persists on whether communication occurs through
nasal secretions or skin to skin contact. See Demaitre, Leprosy in Premodern Medicine,
p.vii, and Boeckl, Images of Leprosy, pp.8-9.
78
On the history of the Sarum rite, see Philip Baxter, Sarum Use: The Development of a
Medieval Code of Liturgy and Customs (Salisbury: Sarum Script, 1994); W.H. Frere,
269
lepers who are leaving the community to enter a leprosarium. The ritual ostensibly
marks the segregation of the leper from the rest of society: he is first led by a priest
from his house to the Church where he undergoes a separation ritual involving the
pronouncement of his symbolic death, after which he is sent home to live in seclusion.
Whilst many historians have taken the inclusion of the separation ritual or ‘leper mass’
in the Missal as evidence of its late medieval performance, this is questioned by the
liturgical historian A. Jeffries Collins, in his 1960 edition of the Sarum Missal.79 Collins
argues that the inclusion of the Mass in the Missal can only be traced as far back as its
sixteenth-century continental printed versions, and he concludes that it formed part of a
group of additions to the manual inserted by its continental printers to give the text
exotic appeal. Carol Rawcliffe, in her Leprosy in Medieval England, cites Collins’s
refutation and decries the ‘tedious’ list of authors who, she notes, continue to ‘cite this
ritual, usually as evidence of the marginality, stigmatisation and isolation of the
medieval leper’.80 For Rawcliffe, the widespread academic acceptance of the reality of
‘Introduction’, in The Use of Sarum, Vol. I. The Sarum Customs as set forth in the
Consuetudinary and Customary, ed. by W.H. Frere (Cambridge: Cambridge University
Press, 1898), pp.x-lviii; Terence Bailey, The Processions of Sarum and the Western
Church (Toronto: Pontifical Institute of Medieval Studies, 1971).
79
A. Jeffries Collins, ‘Introduction’, in Manuale ad usum percelebris ecclesie
Sarisburiensis (London: Henry Bradshaw Society, 1960), pp.xx. Rotha Mary Clay and
Peter Richards both claim that the rite was practiced in England. See Clay, Mediaeval
Hospitals, pp.67-9 and Richards, Medieval Leper, pp.68-9.
80
Rawcliffe, Leprosy, p.21. See also Orme and Webster, The English Hospital, pp.29-
31.
270
the separation ritual has allowed it to become ‘grist to the mill’ in more popular
accounts of medieval leprosy.81
However, even allowing for a lack of evidence of the performance of such a ritual,
this sixteenth-century document can still justify analysis for the insights it gives into
spatial and performative representations of leprosy. It includes elements found in many
late medieval leprosy accounts and narratives: it foregrounds the opposition between
physical suffering and spiritual regeneration, and it cites the ‘man of sorrows’ passage
from Isaiah that informed the devotional trope of the Christum quasi leprosus.
Whatever the economic or seductive motivations of those who drafted the document in
the sixteenth century, its investment in a late medieval poetics of leprosy yields crucial
insights into the configuration of the disease in terms of performance, spectacle and
marginality, even if (or perhaps, especially if) we allow for the essence of such
performance to be purely imaginary.
The ritual overlays spatial movement with the symbolic movement of the leper
from life to death:
In the church let a black cloth, if it can be had, be supported upon two trestles […]
and let the sick man remain on bended knees beneath it between the trestles, in the
likeness of a corpse, although he lives in body and spirit, God willing […]; The
priest then with the spade throws earth upon each of his feet, saying: ‘Be thou
dead to the world [sis mortuus mundo], but alive again unto God.82
81
Rawcliffe, Leprosy, p.21.
82
Manuale ad usum percelebris ecclesie Sarisburiensis, ed. by A. Jeffries Collins
(London: Henry Bradshaw Society, 1960), p.182 (translated after Clay, Mediaeval
Hospitals, pp.273-4).
271
The priest also reassures the leper saying that if he ‘blesses and praises God, and bears
his sickness with patience, he may have a secure hope that although he is sick in body,
his soul may be healthy and he may obtain the gift of eternal salvation’.83 This calls up
the familiar medieval opposition of a sufferer being physically sick whilst being
spiritually healthy, or the achievement of redemption through sickness. The inclusion of
the Isaiah passage, interpreted in terms of Christ’s social and physical resemblance to a
leper, shows how the leper’s social exclusion is itself postulated as spiritually
efficacious. Leprosy is thus imagined here both in terms of the physical disease and
social marginalisation, and both are seen as offering the sufferer spiritual benefits.
The rite then moves from considering the spiritual significance of the exclusion to
describing its quotidian character. At the ceremony’s apex, before the leper returns
home, the priest reads out a list of injunctions:
I forbid you ever to enter into churches, into a market, into a millhouse, into a
bakehouse, and into any public gathering […]. Also, I forbid you ever henceforth
to go out without your leper’s habit, that you may be recognized by others; and
you must not go outside your house without your shoes on […]. Also, I forbid you
ever henceforth to enter taverns or other houses if you wish to obtain wine; take
care even that what they give you they put into your cup. Also, I forbid you to
have any intercourse with any woman except your wife. Also, I command you
when you are on a journey and interrogated by someone, not to return an answer
until you have gone beyond the road to leeward, so that he may have no evil
[male] from you.84
Whereas the leper’s symbolic journey from the Church to his house signifies the final,
irrevocable stage of his death to the world, the priest’s injunctions are replete with
implicit assumptions that the sufferer will participate in the world: he is expected to
83
Sarisburiensis, p.182.
84
Sarisburiensis, pp.183-4.
272
continue to go on journeys, drink water from wells and continue to sleep with his wife.
Even the imperative against the leper going into taverns is mitigated by the affirmation
that he will be able to purchase wine. Far from enacting fantasies of social ostracism,
these injunctions insist upon a tension between ritualistic symbolism and quotidian
social practices. The leper will continue to participate in a variety of situations and
interact with the wider community, but remains marked by a liminal status that
collapses social abjection with spiritual privilege.
The Sarum ritual thus constructs the figure of the leper through a rhetorical mode
that navigates between marginality or invisibility and spectacle. The tableau of the
Mass, with its mixture of sanctification and banishment, is extended into the everyday
world through the very precise injunctions detailing the leper’s movements and
interactions. If the spectre of contagion motivates the ceremony, it is confronted through
its ritual and symbolic performance rather than an insistence upon the leper’s
comprehensive isolation. Indeed, a dynamics navigating between enclosure and latitude
frequently attends late medieval rules and instructions concerning the institutional
arrangements for lepers. The regulations for St. Julian’s leper house near St. Albans,
written in 1146 but revised by its Abbot Michael de Mentmore (d.1349) in 1344,
stipulate that the hospital’s six lepers must live ‘apart from the healthy because of the
peril of contagion [propter contagionis periculum]’.85 In similar terms to the Sarum
separation ritual, these regulations stress the spiritual dimensions of the disease through
the social degradation it engenders:
85
Thomas Walsingham, Chronica Monasterii S. Albani: Gesta Abbatum Monasterii
Sancti Albani, Vol II (1290-1349), ed. by Henry Thomas Riley (London: Longman,
1867) p.484. Translated after Richards, Medieval Leper, pp.129-36.
273
Since, amongst all infirmities, the disease of leprosy is held in contempt, those
who are struck with such a disease should display themselves only at particular
places and times, and, in their bearing and dress, more contemptible and with
greater humility than other men […] Nor should they despair or murmur against
God because of this, but rather praise and glorify him, who, when he was led to
his death, wished to be compared to lepers.86
Again, as with the Sarum ritual, this passage swings between invisibility and display as
the lepers are exhorted to show themselves only at specific points (‘singulis locis et
temporibus’) and then in a condition ‘more contemptible and with greater humility than
other men [tam gestu quam habitu, caeteris hominibus contemptibiliores et magis
humiles]’. These rare, choreographed appearances seem to be oriented towards the
effects they might generate for the viewer. In this sense, the spectacle of the humble and
abject lepers, accentuated by their dress and bodily gestures (‘gestus’), takes the form of
an edifying performance that could both revolt and enthral the beholder who, through
such an arresting visual display, would be reminded of Christ’s own abject state and
bodily disintegration in the Passion. In this way, there are strong parallels between the
delineation of the relationship between the lepers and those who witness them here and
the description of Margery Kempe seeing the lepers in Lynn, and the overwhelming
effect they have on her.
The importance of such displays might shed light on our understanding of the
precise injunctions forbidding the lepers to wander outside of the hospital precinct. The
regulations of St. Julian’s state that, without special permission from the Master of the
house, ‘no brother should presume to travel across the usual boundaries or have
occasion to wander or sojourn through the countryside [vagandi causa per patriam, vel
86
Chronica S. Albani, p.503 (in BL Cotton MS Claudius E IV); Richards, Medieval
Leper, p.131.
274
peregrinandi]’.87 Whilst the inmates of St. Julian’s may go into nearby St. Albans for
business with the permission of the Master, they cannot freely wander about. The
apprehensions of contagion underlining these imperatives are wholly bound up with the
authority (by the leper house’s benefactors responsible for the production of the text) to
calibrate the mobility of the inmates between edifying visibility and institutional
seclusion. Such a poetics of movement makes no distinction between the protean
disease and the amorphous wandering by its sufferers; the contagious potential of
leprosy resides as much in the transgression of spatial and societal demarcations as it
does in the degradation of bodily integrity and the unleashing of ‘evil’ humours.
Indeed, the nebulous language in which the risk of contagion is often suggested,
falling between the body and soul, the physical and the social, the disease and the
management of its sufferers, freights the term ‘leprosy’ with a host of vague fears and
forebodings. As we have seen, this trepidation is often mingled ambivalently with the
allure of the leper, particularly as a site of devotional inspiration. Therefore, the
construction of the leper in institutional writings is that of a figure invested with potent
meaning for the community, expressed through both the enthralment her condition
instigates and the exclusions placed upon her.
This combination of ostracism and intense interest is an integral feature of the
detailed records of the medical examination of Joanna Nightingale of Brentwood in
87
Chronica S. Albani, p.506; Richards, p.135. Likewise, inmates at St. Mary
Magdalene’s leprosarium in Dudston, west of Gloucester, are commanded not to ‘go
outdoors alone, nor should they wander about the streets, but let them go with a servant
or a companion in good order where they have been instructed to go’. See Kealey,
Medieval Medicus, pp.108-9 (p.108). For Latin text, see pp.200-1.
275
Essex in 1468. Nightingale was accused by her neighbours of being a leper but refused
to remove herself from society. A writ was issued from King Edward IV to the sheriff
of Essex stating:
We accept that Joanna Nightingale is a leper, and abides among the people of the
aforesaid county, and communicates with them in both private and public places,
and refuses to transfer to a solitary place, as is customary and befitting her, to the
grave injury of the aforesaid people and, on account of the aforesaid contagious
disease, to their manifest peril .88
The threat of Joanna’s leprosy is conveyed in terms of her unregulated spatial and social
movement: she interacts with the people of Brentwood, mixing with them in private and
public places (‘in locus publicis quam privatis communicat’). Her incessant movement
amongst the community is identified with the contagion of her putative disease.
In addressing this, the writ charges the sheriff, along with ‘discreet and loyal men
of the county’ to visit Nightingale and establish the veracity of the claims. Whilst
further details of this visit are not preserved, Joanna eventually appeared before the
Chancery court.89 Three of Edward IV’s physicians– Roger Marchall (c.1417 – 1477),
88
Thomas Rymer, ed. Foedera, conventions, literae et cuiuscunque generis acta
publica, V, Part II (The Hague: J. Neaulme, 1741), 166. Translated after J.Y. Simpson,
‘Antiquarian Notices of Leprosy and Leper Hospitals in Scotland and England, Parts 2
and 3’, Edinburgh Medical and Surgical Journal, 57 (1842), 121-156 and 394-429.
89
Carole Rawcliffe and Sheldon Watts suggest that Nightingale secured the appearance
at the Chancery court herself, whilst Peter Richards claims that this took place through
the Lord Chancellor’s intervention. See Rawcliffe, Leprosy, pp.186-7; Richards,
Medieval Leper, pp.40-1 and Sheldon Watts, Epidemics and History: Disease, Power
and Imperialism (New Haven: Yale University Press, 1997), p.58.
276
William Hatteclyffe (d.1480) and Dominic de Sergio (d.1475) – performed a judicum,
or formal examination, where she was finally pronounced free of leprosy.90 The report
produced by the physicians for Edward describes their procedure:
First, we examined her person and, in accordance with what the oldest and wisest
medical authorities have found and taught in such cases, we handled and touched
her and made mature, diligent and proper investigation whether the signs that
declared this disease were in her or not. After an examination and consideration of
each of the points, which appeared necessary to be examined and considered, in
order to come to a true acquaintance of this uncertain matter, we found that the
woman neither had been nor was a leper, nor should, for that cause, be removed
from associating with the community. 91
The elongated syntax here with its conditionals and qualifications befits the prose of an
official writ and is designed to assert a sense of orderly, subjective and rational
knowledge slicing through the confusion of claims and counter-claims in the case. It
responds to the amorphous, unchecked wandering of Joanna (and her implicit spreading
of contagion) with a deliberate and comprehensive inspection, based on medical
90
Roger Marchall is the physician notable for his book collections discussed in chapters
one and five of this thesis; for information on Hatteclyffe, see Rosemary Horrox,
‘William Hatteclyffe’, ODNB, http://www.oxforddnb.com/view/article/12603 [accessed
22 May 2013]; for Sergio, see C. H. Talbot and E.A. Hammond, The Medical
Practitioners in England: A Biographical Register (London: Wellcome Historical
Medical Library, 1965) p.36. The performance of a judicum by trained professionals,
judging whether a person should be segregated from the community, tended to be a
feature of continental Europe; in England this responsibility was usually delegated to
laymen. See Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval
English Towns and Cities (Woodbridge: Boydell Press, 2013), p.48.
91
Foedera, p.167.
277
expertise and knowledge of the diseased body. Their intervention works to situate
Joanna’s transgressive movement, and the concern it instigates, within the purview of
medical knowledge, thus nullifying its threat.
Although she is judged free of leprosy, it is notable that the language evoked in
the physician’s judgement is devoid of reference to particular signs or symptoms of
leprosy. In signifying the comprehensive inspection they have undertaken, they list the
four types of leprosy and mention that there are twenty five signs; they affirm that they
have tested Joanna against all of them and have concluded that she is not afflicted with
the disease. 92 The physicians do not mention the particular symptoms she exhibited
which led to her accusation or offer any diagnosis for what condition she might be
suffering from. This is especially pertinent given the typical medical conflation of
leprosy, and its various clusters of symptoms, with other conditions. Instead, the
language of the physicians is formatted to privilege expertise and the articulation of a
decipherable, knowable disease. Whilst the amorphous, proliferating nature of leprosy
may be signalled here in the reference to its more than twenty five signs, this quality is
negated by the physician’s claims of expertise and appeals to the authority of rational
medicine.
Yet despite the writ’s construction of a rational, professional expertise
overcoming public suspicion, it adopts a register that chimes with much of the ritualistic
language that leprosy accrues. The formal certainty with which the physicians
pronounce Joanna ‘absolutely free and exempt [liberam prorsus & immune]’ from the
disease carries an undertone of absolution from sin and is redolent of the language and
authority with which a priest might dispense this. The writ informs us that Joanna was
brought to the physicians by Robert, bishop of Bath and Wells and chancellor of
92
Foedera, p.167.
278
England. Her vindication comes as the result of the physicians’ careful examination of
her. They recount how they ‘handled and touched her [ipsam tractavimus &
palpavimus]’ and made ‘mature, diligent and proper investigation [mature diligenter &
prout oportuit inquisivimus]’ as to whether she evinced the symptoms of the disease or
not; thus they established ‘a true acquaintance of this uncertain matter [pro elicienda
vera notitia hujus ambigui]’.93 The physicians’ expert handling of Joanna’s body is, in
this sense, antithetical to the ungoverned intercourse Joanna is seen to have exhibited
earlier; although their intimate touching might normally exceed the boundaries of social
and sexual decorum, the qualified language insisting upon truth divination and the
safety of the wider community precludes any suspicion here. In particular, the
privileged realm of the medical examination, sanctioned by the mediation of the bishop,
as well as by its textual enunciation addressed to Edward IV, appears inoculated against
the risk of disease communication. It is as if professional touching, by its very order and
authority, mitigates the possibility of contagion – either in the form of physical disease
or through morally, or sexually, illicit transmission.
In this way, the physicians’ professional interaction with Joanna’s body connects
with the pietistic tactility of lepers by devotees such as Margery Kempe or St. Hugh of
Lincoln. Both kinds – medical and devotional - are privileged in the sense that neither
saint nor physician is at risk of contagion, whilst they seek to address or prevent
contagion through the act of touching. In the case of Margery Kempe, her charitable
kissing engenders the leper’s confession thus confronting her moral contagion. The
physicians in the Nightingale writ claim to be working to prevent physical contagion
within the community at Brentwood but, as I have argued throughout this chapter, this
should be seen as inseparable from late medieval understandings of moral or spiritual
93
Foedera, p.167.
279
contagion. I have shown how moral strands are evident in the way that the risk of
contagion appears and disappears in the writ depending on the social and professional
context.
The idea of contagion, like leprosy itself, is always bound up with social and
moral investments. Indeed, it would seem from the inordinate attention given by the
highest echelons of fifteenth-century English society to Joanna Nightingale’s putative
leprosy, that there was a strong, albeit opaque, political dimension to this particular
issue. Whilst we do not know anything about her apart from this writ, the document
presents her staunch refusal to accept the status and subject-position of a leper as a
matter of great importance for her local community and, by implication, the political
realm. Her wandering through the private and public spheres of Brentwood recalls the
transgressive behaviour of Cresseid in Henryson’s Testament and the affliction of
leprosy that is visited upon her by the gods, partly in punishment for her error (and also
expressed in judicial terms).
Such representations exemplify the way leprosy, configured as both a protean and
egregious disease, tends to be negotiated through performance, censure and metaphor in
late medieval English writings. Although often conceived of in terms of alterity and
abjection, the leper is just as likely to be imagined inhabiting the interstices between
bodily sickness and spiritual wellbeing, life and death, inclusion and exclusion. A
productive disgust towards the leper’s body is deployed to provoke desires for haptic
engagement with it as well as for its effacement. The overwhelming nature of leprosy,
attacking ‘all þe body’demands a turn to metaphor and analogy and, with its biblical
inheritance, it asserts itself as a spiritual as well as a physical malaise.94 But, as we have
94
Guy de Chauliac, Cyrurgie, p.377.
280
seen, its many symptoms allow it to be configured in various ways: it is linked to
blasphemy, gluttony, erotic excess, political misrule, and the exemplary sufferings of
Christ. Its protean qualities allow it to assume moral and devotional potency across
medical writings, romance literature, didactic prose, hospital cartularies, official writs
and devotional works; its projection of the internal body and soul upon the sufferer’s
skin enables articulations of disgust, fear, devotion and desire.
281
CHAPTER FIVE
Chaucerian Medicine
The dissemination of medical language throughout a wide variety of Middle English
writings constitutes a medical poetics where the technical language of rational medicine
mediates devotional, didactic, mystical and romantic themes. Such literary
appropriations emerged from the wave of vernacular translations and new productions
of medical writings witnessed in the late fourteenth and fifteenth centuries. This
phenomenon exposed what had previously been largely the preserve of a specialist,
scholastic readership to a wider audience. The principles of scholastic medicine were
elucidated in vernacular surgical treatises, phlebotomy guides, dietaries, commonplace
books and more general encyclopedic works; in many such writings theoretical
medicine overlapped with traditional, empiric material creating a diffuse medical
corpus. This new English medical vocabulary was rich, unstable and multivalent in its
various applications.1 Geoffrey Chaucer’s oeuvre may be seen as a crucible in which
this new vocabulary circulates and attaches itself to a variety of discourses, precisely at
the time when it was seeping into the English language. Chaucer’s work displays an
abiding engagement with medical learning and language, as it does with other sciences
and practical knowledge, and so affords a privileged view of the incorporation of
medical languages within literary discourse.
Despite these abundant and diffuse qualities, those who have explored Chaucerian
medicine have tended to narrow their focus to study the extent of Chaucer’s satirical
1
See Irma Taavitsainen and Päivi Pahta, ‘Vernacularisation’, pp.1-22.
282
treatment of medical practitioners. Walter Clyde Curry’s Chaucer and the Mediaeval
Sciences (1926) comprised the first sustained critical treatment of medicine in
Chaucer’s works. Curry reads Chaucer’s characterisations in the Canterbury Tales in
light of late medieval medical knowledge and theory: for example, commenting on the
description of the Doctor of Physic in the ‘General Prologue’, Curry pronounces that he
‘seems to be an outstanding representative of the theoretical and practising physicians of
his time. But as to his character – that is another matter’.2 Continuing to focus on their
descriptions in the ‘General Prologue’, he goes on to diagnose the Summoner as
suffering from leprosy and the Reeve as choleric.3 In the 1970s, Huling Ussery again
looked at Chaucer’s employment of medical theory and advanced that the representation
of the Physician in the Canterbury Tales is modelled on contemporary practitioners and
that its satiric elements have been exaggerated.4 Yet the subject of satire has continued
to dominate discussion of Chaucer’s use of medicine. Faye Getz, for example, argues
that Chaucer borrowed from the European continent an interest in medical
scholasticism, as well as a corresponding suspicion of those who practice medicine.5
For Getz, scholastic and empiric medicine, and related disciplines such as
physiognomy, offered Chaucer a means to portray his characters, particularly in the
2
Walter Clyde Curry, Chaucer and the Mediaeval Sciences, 2nd edn. (New York: Allen
and Unwin, 1960), p.27.
3
Curry, Mediaeval Sciences, pp.37-53 and 71-90. Jill Mann also registers the
ambivalence with which the Physician is depicted. See Mann, Chaucer and Medieval
Estates Satire, p.97.
4
Ussery, Chaucer’s Physician, pp.91-139.
5
Faye Getz, Medicine in the English Middle Ages (Princeton: Princeton University
Press, 1988), p.88.
283
‘General Prologue’, by describing their internal or moral state through their outward
appearances and complexions.6 Nonetheless, she concludes that Chaucer’s belief in a
preventative, moderate health regimen informed his ultimate distrust of medical
practitioners.7
In his thesis on medicine in Chaucer, Jake Walsh Morrissey argues similarly that
Chaucer’s engagement with professional medical healing is one characterised by
distrust and negation. Morrissey’s thesis is an analysis of the ways that Chaucer and
John Lydgate employed ‘nonliterary medical texts in transporting medical discourse
into the English language and culture’.8 He argues that whereas Lydgate engaged with
the popular genre of the regimen sanitatis, or health regimen, and adopted it for a
literary audience, Chaucer’s use of medicine was based on an undermining of scholastic
medicine in the interests of privileging the health of the soul. In making this argument,
Morrissey pays close attention to the framework of the Canterbury Tales’ narrative.
Defining the Canterbury pilgrimage as a quest for health, he proposes that the characters
of the Physician, Pardoner and Parson exemplify competing health ideals. He argues
that Chaucer refutes the physical healing of the Physician (by presenting him as a selfinterested manipulator) and the fraudulent spiritualism of the Pardoner, favouring
instead the Parson’s emphasis on spiritual health.9
6
Getz, Medicine in the English Middle Ages, p.88.
7
Getz, Medicine in the English Middle Ages, p.90.
8
Morrissey, ‘“Termes of Phisik”’, p.i.
9
Morrissey, ‘“Termes of Phisik”’, pp.30-105. Morrissey also argues that Chaucer’s
adoption of medical terminology in the description of amor hereos, or lovesickness, in
the ‘Knight’s Tale’ negates the medicalisation of this condition. He claims that it does
284
This chapter departs from Morrissey’s (and, consequently, Curry’s and Getz’s)
analyses in a number of respects. Although the narrative frame of the Canterbury Tales
reveals something of popular medicine and its reception (particularly as inflected
through the link between the Physician’s and Pardoner’s Tales), it affords only a partial
perspective of the dynamics at play in Chaucer’s use of medical terms. Consequently, I
focus here on the modes of medical discourse that Chaucer employs and the ways in
which he investigates and plays with their metaphorical, symbolic or referential
meanings. In doing this, I include and go beyond the Canterbury Tales seeking evidence
across his wider oeuvre. Furthermore, whilst agreeing that Chaucer does incorporate
features of anti-medical satire in his writings, I argue that this is one of a variety of
ways in which he employs medical discourse.10 Instead of framing the debate around
the extent to which he accepted or dismissed a coherent ‘body’ of medical knowledge, I
argue instead that he deployed medical learning and discourse in ways consistent with
its diversity and heterogeneous manifestations in late medieval English culture. Indeed,
the presence of Boethian philosophy, Scriptural ethics, humoral theory, practical
surgery and amuletic charms in the writings of Chaucer’s London contemporary, John
Arderne, clearly demonstrates such multiplicity, and the blurred disciplinary boundaries
this through articulating the symptoms of lovesickness, whilst dismissing the idea that
medical learning offers a cure for lovesickness. See Morrissey, ‘“Termes of Phisik”’,
pp.106-98.
10
In similar terms, a reading of the representation of the Physician in the ‘General
Prologue’ by Carole Rawcliffe finds that Chaucer’s description provides no explicit
condemnation of the Physician. See Rawcliffe, ‘The Doctor of Physic’, in Historians on
Chaucer: The ‘General Prologue’ to the Canterbury Tales, ed. by Stephen H. Rigby
and Alastair Minnis (Oxford: Oxford University Press, 2014), pp.297-318 (p.300).
285
attending even the most practical articulations of medicine circulating in Chaucer’s
England. From this viewpoint, I question a dualistic reading of his privileging of
spiritual over physical healing by analysing aspects that show the way these categories
are linguistically interwoven in his writings.
I begin by showing how the scalp condition called the ‘scalle’ is articulated in
metaphorical and moral terms in Chaucer’s words to his scribe Adam. I consider the
extent to which such an appropriation of medical knowledge might be grounded in the
circulation of medical texts in late medieval England. I go on to consider Chaucer’s
employment of medical satire – the basis of much previous readings of Chaucerian
medicine – and argue that, whilst he embeds anti-medical satirical discourse in his
writings, this does not exclusively signify an anti-medical stance, but instead comprises
one strand of a disparate engagement with what was a highly complex field of
knowledge framed by vague borders. I go on to examine the way that the medical
interacts with the philosophical or ethical in Chaucer’s corpus, and I analyse the way
that he foregrounds the obfuscations and exclusions of medical terminology. Finally, I
explore the representation of the poetic subject through the vaguely defined but potent
condition of melancholy.
286
Skin disease and Textual Defacement in ‘Chaucer’s Wordes unto Adam, His Owne
Scriveyn’
The single stanza that appears in a manuscript of Chaucer’s and Lydgate’s shorter
poems, in Cambridge, Trinity College MS R.3.20, carrying the title ‘Chauciers wordes .
a Geffrey vn to Adame his owen scryveyne’, makes a metaphorical and punitive
connection between the material act of writing (transcribing, erasing, amending) and a
skin condition affecting the scalp called ‘the scalle’:
Adam scriveyn, if ever it thee bifalle
Boece or Troylus for to wryten newe,
Under thy long lokkes thou most have the scalle,
But after my makyng thow wryte more trewe;
So oft adaye I mot thy werk renewe,
It to correcte and eke to rubbe and scrape,
And al is thorugh thy negligence and rape.11
This poem has attracted much interest due to its distinctive place in Chaucer’s canon,
comprising as it does a reference to the ‘makyng’ of Chaucer’s poetry and its scribal
transmission. Linne R. Mooney’s identification in 2004 of the London scrivener, Adam
Pinkhurst, as the scribe of both the Hengwrt and Ellesmere manuscripts of the
Canterbury Tales, and the possible subject of this poem, helped to intensify interest in
11
‘Chaucer’s Wordes unto Adam, His Owne Scriveyn’, in RC, p.650. All quotations
from Chaucer’s works in this chapter are in RC. Line numbers are cited parenthetically
in the text along with fragment, in works from the Canterbury Tales, and relevant book
and/or section in other works.
287
it.12 Whilst the attribution of the poem to Chaucer, by the manuscript’s scribe John
Shirley (c.1366-1456), has been called into doubt, it continues to be accepted within the
Chaucerian canon.13
Notwithstanding assertions by some critics that the poem’s precision of reference
curtails its yield of interpretative readings, many of its readers have displayed a sharp
awareness of its intertextual and linguistic resonances.14 The seven-line single-stanza
12
Mooney first revealed her findings at a conference of the New Chaucer Society in
2004. They were subsequently published under the title of ‘Chaucer’s Scribe’,
Speculum, 81:1 (2006), 97-138.
13
See Seth Lerer, Chaucer and his Readers: Imagining the Author in Late Medieval
England (Princeton: Princeton University Press,1993), p.121, and A.S.G. Edwards and
Julia Boffey, ‘“Chaucer’s Chronicle”: John Shirley and the Canon of Chaucer’s Shorter
Poems’, Studies in the Age of Chaucer, 20 (1998), 201-18. Whereas Lerer speculates
that Shirley may have written the poem himself, Edwards proposes that it could have
been written as a reprimand by a ‘supervisory scribe’ to a junior one. See A.S.G.
Edwards, ‘Chaucer and “Adam Scriveyn”’, Medium Aevum, 81:1 (2012), 135-138
(p.136). On the dubious nature of Shirley’s claims about Chaucer, see Margaret
Connolly, John Shirley: Book Production and the Noble Household in FifteenthCentury England (Aldershot: Ashgate, 1998).
14
John Scattergood, for instance, takes the view that the poem gives only limited scope
for interpretive readings, see ‘The Jongleur, the Copyist and the Printer: The Tradition
of Chaucer’s Words unto Adam, His own Scriveyn’, in Courtly Literature: Culture and
Context: Selected Papers from the Fifth Triennial Congress of the International Courtly
Literature Society, ed. by Keith Busby and Erik Kooper (Amsterdam and Philadelphia:
John Benjamins, 1990), pp.499- 508 (p.500). This claim is undermined by the
288
poem written in rhyme royal is the shortest known work attributed to Chaucer
(discounting his rhymed proverbs); it is formally related to the book curse, an
imprecation often included in medieval manuscript volumes and ‘designed to protect a
codex by threatening spiritual or physical punishment for anyone who steals, defaces or
otherwise misuses it’.15 The curse in ‘Adam Scriveyn’ (the name by which I refer to the
poem here) is that of the ‘scalle’, a term that encompassed a variety of conditions of the
scalp typically evinced by blisters, scabs or scaly skin (possibly akin to eczema or a
fungal infection). In Trevisa’s translation of Bartholomaeus Anglicus’s De
proprietatibus rerum, it is given the name ‘moþþe’ due to the way it eats into the skin as
a moth eats into cloth (the metaphor’s vehicle being symmetrical to that of the
parchment in ‘Adam Scriveyn’). Similar to its description in Chaucer’s poem,
Bartholomaeus describes it as inducing ‘passinge greet icchinge and fretinge [in þe
heed. And after cracching] and clawinge of þat icchinge falliþ many scales’.16 In
‘Adam Scriveyn’, the condition is to be visited upon the scribe in the event of his
negligent or hasty copying. The invocation of this disease as a punishment for these
particular faults is metaphorically significant. Critics of the poem have noted the
appropriate symmetry between the poet’s need to ‘rubbe and scrape’ the manuscript
perspicacious readings offered by, among others, Carolyn Dinshaw, Alexandra
Gillespie and Jay Ruud, mentioned below.
15
Glending Olson, ‘Author, Scribe and Curse: The Genre of “Adam Sriveyn”’, The
Chaucer Review, 42:3 (2008), 284-297 (p.285). John Scattergood has similarly related it
to the Provençal genre known as sirventes joglaresc, comprising a rebuke by a poet to a
jongleur for an inaccurate performance of the poet’s work. See Scattergood, ‘The
Jongleur’, pp.501-2.
16
Bartholomaeus Anglicus, Properties of Things, p.345.
289
parchment in correcting the scribe’s errors and the scribe’s ensuing itching of his own
skin as a result of the onset of the disease.17 In this sense, the parallelism is an example
of the model of the symmetrical Christian justice, saliently outlined in Dante’s Divina
Commedia, known as contrapasso where the sinner’s punishment directly recalls his or
her sin.18
Being a disease of the skin, the condition inevitably carries a moral dimension. In
particular, its scaly feature could provoke associations with certain forms of leprosy; the
fourteenth-century Middle English version of biblical and religious history known as the
Cursor Mundi relates King Herod’s cruelty and pride to a variety of illnesses including
the ‘scall’: ‘Þe parlesi has his a side,/ þat dos him fast to pok his pride;/ In his heued he
has þe scall’.19 The connection between the sin of pride and Adam Scriveyn, although
not one explicitly made in the poem, has been considered by some mainly due to the
parallels in the poem between Adam, the scribe, and the biblical Adam. The poem
suggests this association with the words ‘Adam’ and ‘befalle’ framing its first line, and
through the implicit parallelism between the divine creator God and the poet, Chaucer,
reprimanding his scribe for undermining his ‘makyng’.20 Indeed, the poem’s post17
Jay Ruud, “Many a Song and Many a Leccherous Lay”: Tradition and Individuality
in Chaucer’s Lyric Poetry (New York: Garland, 1992), p.122, and Russell A. Peck,
‘Public Dreams and Private Myths: Perspectives in Middle English Literature’, PMLA
90:3 (1975), 461–67 (p.467).
18
See Britt Mize, ‘Adam, and Chaucer’s Words unto Him’, The Chaucer Review, 35:4
(2001), 351-77 (pp.359-60).
19
Cursor Mundi, l.11817-19.
20
Carolyn Dinshaw, Chaucer’s Sexual Poetics (Wisconsin and London: University of
Wisconsin Press, 1989), pp.6-8.
290
lapsarian acknowledgement of the evasiveness of an ultimately truthful copy of the
poet’s work, settling for one that is merely ‘more trewe’, further indicates the
significance of the reference to Adam.21 Whilst the link between Adam Scriveyn’s
imputed ‘scalle’ and pride is largely made through the implicit nominal association
(although his ‘long lokkes’ may betoken a preoccupation with appearance),22 Brendan
O’Connell argues that the condition may be linked more directly to falsification.
O’Connell notes Dante’s description of falsifiers undergoing purgatorial punishments
including diseases of the scalp and suggests this as informing the selection of the
‘scalle’ as punishment for the misrepresentations wrought through Adam’s work.23 Such
a reading also accords with the description of another falsifier from the ‘General
Prologue’ of the Canterbury Tales, the Summoner, who among his various ailments is
beset by ‘scalled brows’ (I, 627).
The reference to the ‘scalle’ in ‘Adam Scriveyn’ is indicative of the way in which
medical terms are imbedded within moral and metaphorical lineaments in Chaucer’s
writings. The symptoms of the condition, which are explicitly outlined in contemporary
medical treatises, are, in this poem, knowingly and playfully implied through the
reference to rubbing and scraping parchment. Instead of the term being the subject of
medical healing, it becomes here a curse. The (mocking) parallelism between rubbing
21
This argument is made by Alexandra Gillespie in her incisive reading of the poem.
See, ‘Reading Chaucer’s Words to Adam’, The Chaucer Review, 42:3 (2008), 269-283
(see especially, pp.278-79).
22
See Mize, ‘Adam, and Chaucer’s Words’, pp.364-6.
23
Brendan O’Connell, ‘Adam Scriveyn and the Falsifiers of Dante’s Inferno: A New
Interpretation of Chaucer’s Wordes’, The Chaucer Review, 40:1 (2005), 39-56 (pp.4553).
291
the parchment and scratching one’s head aligns the ‘negligence and rape’ of texts, or
language, with that of bodily disease, underlining the connection between the text’s
language and the body it signifies.
Chaucer’s Medical Sources
‘Adam Scriveyn’ exemplifies how Chaucer employs medical language to uncover
religious and moral resonances and associations. But how might a reader like Chaucer
have encountered medical learning? And could these encounters have informed his
metaphorical purchase on medical language? This section considers the kinds of textual
material he would have had access to, and the forms and contexts in which he would
have received them. The absence of evidence of Chaucer’s acquisition of a university
education suggests that his encounter with scholastic medicine would have been
accommodated by the wider dissemination of medical learning taking place in England
and beyond in the fourteenth century. Although such propagation was aided by the
increase of vernacular works, Chaucer’s sustained use of Latin texts in his works
implies that he possessed at least a working knowledge of it, and that, therefore, he
could have gleaned his medical knowledge from texts written in Latin, English or
French.
The diverse character of late medieval English medical manuscripts points to the
miscellaneous way in which a reader such as Chaucer could have encountered this
knowledge. In such works, scholastic medicine mingled with herbal recipes and charms,
the characteristic material of a non-scholastic vernacular remedy-book tradition (that
had existed from around the ninth century); these miscellanies achieved wide circulation
292
and practical application beyond the world of the university.24 In England, encyclopedic
texts, in particular, achieved much popularity amongst general readers, and tended to
incorporate a wealth of medical information. The genre’s consolidation of theology,
philosophy, natural philosophy, medicine and folkloric knowledge reflected the late
medieval appetite for interconnectedness and equilibrium between fields of learning,
and for an over-arching totality of knowledge. The encyclopedic text followed the
scholastic medical treatise in its deployment of authoritative literature. It typically
begins with descriptions of God and the cosmos, and then moves on to explicate the
orders of angels, man (including humoral make-up, temperament, diseases and their
cures), the elements and a taxonomy of animals.25 Similar to the scholastic medical
compendia, these highly popular works were translated into the vernaculars of a range
of European countries over the fourteenth and fifteenth centuries.
The sprawling encyclopedic trifecta of the French Dominican, Vincent of
Beauvais (c.1190-c.1264), entitled the Speculum Maius, has been considered a
significant source for Chaucer’s medical references. In 1935, Pauline Aiken identified
references in two books of the Speculum – the Speculum Naturale and the Speculum
Doctrinale – which accorded closely with the humoral basis of dreams outlined in the
‘Nun’s Priest’s Tale’ by the hen-character, Pertolete.26 Chaucer’s familiarity with
24
Irma Taavitsainen and Päivi Pahta, ‘Vernacularisation’, p.11, and Claire Jones,
‘Elaboration in Practice’, pp.163-77.
25
Irma Taavitsainen, ‘Science’, p.382.
26
Pauline Aiken, ‘Vincent of Beauvais and Dame Pertelote’s Medicine’, Speculum,
10:3 (1935), 281-7. See also W.K. Wimsatt, ‘Vincent of Beauvais and Chaucer’s
Cleopatra and Croesus’, Speculum, 12:3 (1937), 375-81.
293
Vincent is attested to in his Legend of Good Women by a reference to the third book of
Vincent’s encyclopedia, the Speculum Historiale, and its examples of moral women.27
Aiken supports her claims by locating the herbs listed in the ‘Nun’s Priest’s Tale’ in two
chapters of the Speculum, and points to Vincent’s discussion of the influences of red
cholera and melancholy on dreams, and its resemblance to Pertolete’s description.28 As
with the medical compendia, Vincent’s work, with its extended quotations and passages
from a diverse range of medical authorities, would seem to offer a reader such as
Chaucer a neat array of scholastic information from which to draw.
Another candidate for informing Chaucer’s medical engagement must be
Bartholomaeus Anglicus’s De proprietatibus rerum, one of the most popular
encyclopedic works across Europe in the later Middle Ages. Bartholomaeus, a
Franciscan who taught at Paris, cited a range of writings throughout his work including
the canonical medical works of Constantinus Affricanus, Gerard of Cremona’s (c.11141187) translations of Galen’s works, the Aphorisms of Hippocrates and Arabic authors
27
The Legend of Good Women, RC, G, 307. For the corresponding section in the
Speculum see, Vincent de Beauvais, Speculum historiale, in Speculum quadruplex sive
Speculum maius: naturale, doctrinale, morale, historiale, 4 vols. (Douai, 1624; repr.
Graz: Akademische Druck, 1964), Bk 6, 108-122. The Wife of Bath’s lines of the
virtues of poverty (III, 1995-2000) have also been sourced to the Historiale. See note in
RC, p.874. See Vincent de Beauvais, Speculum Historiale, Bk 10, p.71.
28
Aiken, ‘Vincent of Beauvais’, pp.281 and 283-4.
294
such as Ibn Sīnā and Haly Abbas.29 The popularity of this work is manifested in its
frequent presence in manuscript collections throughout Europe; twenty three manuscript
versions of it are extant in England.30 In 1372, a French translation by Jean Corbechon
(fl. c.1370) was commissioned by Charles V (1338-80) of France, followed by Trevisa’s
Middle English translation (1397).31 Although Chaucer makes no reference to the work
in his writings, it is probable that he would have had some knowledge of it, either in its
Latin or French version.32 There is much in the work that resonates with Chaucer’s
employment of medical registers: it outlines humoral theory and its effects on a person’s
behavior and disposition, knowledge that is employed throughout Chaucer’s corpus;
Bartholomaeus’s description of melancholy, its black quality and the dread of death it
inspires, is echoed in the Book of the Duchess’s description of the Black Knight (16-29),
as well as that of mania in the ‘Knight’s Tale’ (I, 1373-1376);33 Chaucer’s allusions to
29
Taavitsainen, ‘Transferring Classical Discourse Conventions into the Vernacular’, in
Medical and Scientific Writing, ed. by Irma Taavitsainen and Päivi Pahta, pp.37-72
(pp.59-61).
30
Peter Brown, Optical Space, p.78.
31
See Sue Ellen Holbrook, ‘The Properties of Things and Textual Power: Illustrating
the French Translation of De proprietatibus rerum and a Latin Precursor’, in Patrons,
Authors and Workshops: Books and Book Production in Paris around 1400, ed. by
Godfried Croenen and Peter Ainsworth (Louvain: Peeters, 2006), pp.367-404.
32
The French royal commissioning of the text demonstrates its popularity in court
circles, and Chaucer could have come across the text either in England or on his
diplomatic visits to France in the late 1370s. See Pearsall, The Life of Geoffrey
Chaucer: A Critical Biography (Oxford: Blackwell, 1992), pp.105-6.
33
See Bartholomaeus Anglicus, Properties of Things, Bk. 4, Ch. 11, pp.159-162.
295
medical theory in the ‘Knight’s Tale’, comprising a reference to the ‘celle fantastik’ (I,
1376), one of the three chambers of the brain in medieval medical theory, and the ‘vertu
expulsif’ (I, 2742-2760), denoting, in this context, the body’s predisposition to expel
corrupt blood, are paralleled by their treatment in the Properties of Things.34 More
importantly, the range of reference in the encyclopedic text, the panorama it presents of
a world defined by order, coherence and layered patterns of overlapping skeins, chimes
with Chaucer’s heterogeneous employment of medical languages. As Helen Rodnite
Lemay says, referring to another medieval encyclopedist, Albertus Magnus (c.12061280), ‘encyclopedists give a sweeping view of the world, including God and the angels
in their purview. They draw indiscriminately from theological, philosophical and
medical sources and have no sense of writing within a specific discipline’.35 Thus, the
tetralogical perspective of the body (composed of four humours and linked to the four
elements, seasons and phases of the moon), offered by Galenic medicine, is expanded
upon in encyclopedias to encompass the four ages of man, and is situated within a more
34
For the division of the brain into three chambers, see Bartholomaeus Anglicus,
Properties of Things, Bk. 5, Ch. 3, pp.172-77; for Bartholomaeus’s definition of the
expulsive virtue, see Properties of Things, Bk. 3, Ch. 8, p.97; for corrupt blood, see
Properties of Things, Bk. 4, Ch. 8, pp.153-7.
35
Helen Rodnite Lemay, ‘Introduction’, in Women’s Secrets: A Translation of Pseudo-
Albertus Magnus’ De Secretis Mulierum with Commentaries (Albany, NY: State
University of New York Press, 1992), pp.1-58 (p.11).
296
overtly Christian-informed cosmology.36 Such inter-connections may be seen as
informing the cross-disciplinary surge of Chaucerian medicine.37
Yet the highly referential and compendious nature of late medieval medical and
encyclopedic texts undermines any definitive claims of correspondence between
Chaucer’s employment of medical knowledge and such sources. Aiken’s assertion that
‘every detail of medical theory and practice not only in the ‘Nun’s Priest’s Tale’ but in
the whole body of Chaucer's works […] may be found in [Vincent’s] great
encyclopedia’ is undermined by the fact that Vincent’s writings, as with others, are
compilations of a panoply of other authoritative texts.38 Because a great many of
Vincent’s sources were in circulation in late medieval England, they cannot be easily
discounted.39 Chaucer’s own references, in his writings, to Constantinus Africanus and
36
Linda Ehrsam Voigts, ‘Bodies’, in A Companion to Chaucer, ed. by Peter Brown
(Oxford and Malden, MA: Blackwell, 2002), pp.40-57 (pp.41-2).
37
For discussion of the influence of such knowledge on Chaucer’s writings, see Ann W.
Astell, Chaucer and the Universe of Learning (Ithaca, NY and London: Cornell
University Press, 1996), and J.D. North, Chaucer’s Universe (Oxford: Clarendon Press,
1988).
38
Aiken, ‘Vincent of Beauvais’, p.286.
39
Robert A. Pratt suggests that Robert Holcot’s (c.1290-1349) commentary on the Book
of Wisdom, Super Sapientiam Salomonis, is the principal source for the discussion of
dreams in the tale; however, he agrees with Aiken’s view that the medical content of the
tale was sourced from Vincent of Beauvais. See Pratt, ‘Some Latin Sources on the
Nonnes Preest on Dreams’, Speculum, 52:3 (1977), 538-70 (p.546); Edward Wheatley,
‘The Nun’s Priest’s Tale’, in Sources and Analogues of the Canterbury Tales, ed. by
297
his work De coitu, the Trotula and Ibn Sīnā and his Canon, indicates a knowledge of
some of the most prominent medical texts and writers in the canon, but these could be
sourced to any number of compilations or references in other medical works.40
Furthermore, the manuscript circulation of Vincent’s work in England appears, like
many such works, to have been characterized by fragmentation where only certain
portions of the text were copied.41
A more productive line of enquiry is to examine more generally the kinds of
books and collections in which medical information circulated, particularly amongst the
Robert M. Correale and Mary Hamel, Vol. I (Cambridge: D.S. Brewer, 2002-2005),
pp.449-52 (p.452). Jake Walsh Morrissey also proposes Vincent, along with Bernard of
Gordon and John of Gaddesden, as the medical sources for Chaucer’s descriptions of
amor hereos. See Morrissey, ‘“Termes of Phisik”’, pp.171-81.
40
See Canterbury Tales, IV, 1810-11; III, 671-85; VI, 889-90.
41
For example, the humoral information outlined in chapter thirty-two of the Speculum
doctrinale formed part of an eleven-chapter fragment of the volume in a manuscript
written in Latin in the early fourteenth century, London, BL Add MS 15583. This was
owned by the Cistercian abbey of St. Mary of Camberon in Hainault, Essex. Four Latin
manuscript volumes of the Speculum historiale, produced around the beginning of the
fourteenth century, belonged to St. Augustine’s monastery at Canterbury. Alternatively,
Chaucer could have encountered a French translation of the Speculum historiale by Jean
de Vignay (c.1283-c.1340). Most of the forty extant volumes of this text were made at
Paris in the late fourteenth or early fifteenth centuries. See George F. Warner and Julius
P. Gilson, Catalogue of Western Manuscripts in the Old Royal and King’s Collections,
4 vols (London: British Museum, 1921), II, p.139.
298
classes of urban professionals and courtly esquires, in later medieval England. The
figure of physician and medical writer, Roger Marchall, provides an example of the way
scholastic medical knowledge could be absorbed into a non-university sphere.42
Marchall studied medicine at Cambridge, but moved to London where he became a
physician of Edward IV and amassed much wealth through trade with London
merchants, mainly ironmongers. His service for Edward IV is attested to in his inclusion
as signatory to the record of the inspection of Joanna Nightingale for leprosy (discussed
in chapter four of this thesis). Marchall used his wealth to acquire a considerable
selection of medical and scientific works, and he seems to have commissioned a number
of books from one London scribe. He donated his manuscripts to three Cambridge
colleges before his death. His London career began more than fifty years after
Chaucer’s death. However, his linking of the academic medical world of the university
with the London mercantile one (as well as the royal court) and his close involvement
with the production and circulation of books provides an important perspective into the
opportunities of access that were open to a reader such as Chaucer in his quotidian
professional life.
This movement of books between the university, court and the professional orbit
was paralleled by the heterogeneous make-up of the books themselves. Many were
miscellanies that brought together a diverse array of literature including theological,
devotional, medical and literary material. As reading communities emerged from
42
See Linda Ehrsam Voigts, ‘A Doctor and his Books: The Manuscripts of Roger
Marchall’, in New Science out of Old Books: Studies in Manuscripts and Early Printed
Books in honour of A.I. Doyle, ed. by R. Beadle and A. J. Piper (Aldershot: Scolar
Press, 1995), pp.249-314.
299
professional groups, the demand for books that fulfilled a range of desires and needs,
including entertainment, edification and practical knowledge, increased.43 Fachliteratur,
or practical literature, encompassing a range of technical subjects such as courtesy,
equestrianism, lace-making and, most prominently, medical practice and knowledge,
tended to feature heavily in such miscellanies.44 A late fourteenth-century miscellany
housed in the British Library typifies this kind of book. London, BL Royal MS 17 A III
is a collection of medical and other practical literature alternating between Latin and
Middle English: this small, compact volume comprises tracts on urine and phlebotomy
with various medical recipes including instructions on how to make ‘blak sope’ and
‘mede’.45 It also includes material drawn more directly from scholastic medicine
including a list of the hours of the day with their corresponding humours, and Latin
43
Peter Murray Jones, ‘Information and Science’, in Fifteenth-Century Attitudes:
Perceptions of Society in Late-Medieval England, ed. by Rosemary Horrox (Cambridge
and New York: Cambridge University Press, 1994), pp.97-111.
44
Linda Ehrsam Voigts, ‘Scientific and Medical Books’, in Book Production and
Publishing in Britain, 1375-1475, ed. by Jeremy Griffiths and Derek Pearsall
(Cambridge and New York: Cambridge University Press, 1989), pp.345-402 (p.347).
See also Laurel Braswell, ‘The Moon and Medicine in Chaucer’s Time’, Studies in the
Age of Chaucer, 8 (1986), 145-56. For the origins of the concept of fachliteratur, see
Peter Assion, Altdeutsche Fachliteratur, Grundlagen der Germanistik, (Berlin: Schmidt,
1973), pp.55-7.
45
London, BL Royal MS 17 A III, ff.106 and 123b.
300
extracts from a book of combined writings of Galen, Hippocrates and Aristotle.46 But
the manuscript also includes other practical texts such as a nominale, or Latin-English
vocabulary of nouns, and a table of Arabic numerals.47 Although the owner of this text
is unknown, a clue may be afforded by the inclusion of an English translation of a 1365
summons calling on the Weavers of London to produce the warrant by which they claim
to hold their guild. The incorporation of this document within the manuscript again
suggests a link between the London mercantile world and the circulation of medical
(and other practical) texts.
This miscellany also includes a lunary, a prognosticative text based on the lunar
cycle, known as the Thirty Days of the Moon. This text, usually written as a poem with
rhyming couplets (as it is here), predicts the fortunes, characteristics and physical
disposition of a child born on each day of the lunar month, and associates biblical
figures such as Adam and Eve, and Noah and Abraham with astrological influence.48
However, it is addressed to practitioners and its primary function, as outlined in its
prologue here, is that ‘lewide men schulden knowe hereby whanne it were good tyme to
46
Royal MS 17 A III, f.17b. The volume also includes the same treatise on rosemary
putatively commissioned by the Countess of Hainault discussed in ‘The Practitioner’
chapter in this thesis (ff.181-183b).
47
Royal MS 17 A III, f.13.
48
For examples see, Laurel Means, ed., Medieval Lunar Astrology: A Collection of
Representative Middle English Texts (Lewiston, NY: Mellon, 1993). See also Irma
Taavitsainen, Middle English Lunaries: A Study of the Genre (Helsinki,: Société
Néophilologique, 1988).
301
leten blood and gode tyme to ȝeue medicyn’.49 ‘Lewide’ could refer alternatively to
those unlearned in Latin or non-clerical (and thus non-university trained) practitioners.
The word, in this sense, might describe John Crophill (d. c.1485), the Essex bailiff and
medical practitioner whose name, like Chaucer’s or Arderne’s, is not associated with
any university, and who compiled a densely illustrated manuscript of medical material
for his own use.50 The volume, largely written by a professional scribe with additions in
Crophill’s own hand (including a list of patients he treated), begins with the Thirty Days
poem.51 It is prefaced here with a validatory prayer which embeds the lunary’s
prognostications within God’s divine plan and endorsement of human understanding of
astrology.52 The preface provides an ontological context, not only to the following
poem, but to the complex and highly detailed tables outlining the planets, with their
calendrical and numerical equivalents, as well as the volume’s inclusion of texts on the
humours, urine, alchemy and onomancy.
The Thirty Days was an immensely popular text and is found in various late
medieval English manuscripts.53 In a fifteenth-century manuscript held at the Wellcome
library, it appears with astrological tables and calendars, again, but also with John
49
BL Royal MS 17 A III, f.91.
50
See J. K. Mustain, ‘A Rural Medical Practitioner in Fifteenth-Century England’,
Bulletin of the History of Medicine, 46 (1972), 469–76. See also works on Crophill cited
in chapter one of this thesis.
51
London, BL Harley MS 1735.
52
Harley MS 1735, ff.1-13v.
53
Taavitsainen, Lunaries, pp.153-7.
302
Lydgate’s equally popular ‘Dietarie’ and an itinerary of a pilgrimage to Jerusalem.54 An
ascription of the compilation to an unknown ‘Richard of Lincoln’ (or possibly, ‘of
London’) in a folio of the manuscript has been recovered in recent years, following its
earlier erasure, and the volume’s medical content has led some to conclude that Richard
was a practitioner.55 But, as has we have seen, the presence of medical material in a
miscellany does not preclude a non-medical professional ownership.56 The convening,
in the Wellcome manuscript, of the pilgrimage itinerary and Lydgate’s ‘Dietarie’, where
wellbeing is conceived of in terms of spiritual and bodily health, along with the Thirty
Days, signifies an inclusive idea of sickness and health, and suggests an equally wide
reception. Indeed, the fluid adaptability of such practical literature is shown by the way
they emerge in different, overlapping combinations in miscellanies such as John
Shirley’s Trinity manuscript where the Thirty Days appears under the Lydgatian title of
‘A dyetarie for man’s heele’, amidst that collections entertaining and edifying works.57
Another manuscript in the British Library’s Royal collection, produced in the fifteenth
century, features the Thirty Days and charms in Middle English, along with Latin works
including a commentary on Aristotle by the English philosopher Walter Burley (c.1274-
54
London, Wellcome Historical Medical Library MS 8004.
55
This view is reflected in the title of a recent account and translation of the pilgrimage
text in the manuscript: Francis Davey, Richard of Lincoln: A Medieval Doctor travels to
Jerusalem (Broadclyst, Exeter: Azure, 2013).
56
Monica Green proffers instances of owners or commissioners of medical works who
were not practitioners such as the Norfolk aristocrat, Sir John Paston and Suffolk
lawyer, Thomas Stoteville. See Green, Women’s Healthcare, pp.37-41.
57
Cambridge, Trinity College, MS R.3.20, f.135.
303
c.1344), the devotional writings of Richard Rolle and the astrological Kalendrium of
John Somer (d. c.1409), a text cited by Chaucer in his Treatise on the Astrolabe.58
A reader like Chaucer, in the latter quarter of the fourteenth century, would have
been likely to have encountered medical information bound with other practical,
devotional and literary texts in such miscellanies. It is therefore appropriate to see
Chaucerian medicine, with its sensitivity to medical metaphors and to medicine’s moral
encodings, as emerging from the blending of fields of knowledge characteristic of
miscellanies. This is as much to do with the diffuse organisation of miscellanies as with
the way that the interlacing of medicine, morality and Christian devotion informs the
contents of specific texts included in them. The circulation of such material among
coteries of urban professionals, including medical practitioners, at the fringes of (or
entirely marginal to) the university, as well as within domestic households and at court,
suggests that such material could be employed in disparate ways. This problematises
Monica Green’s claim that medical literature, in such contexts, was ‘read for
information rather than pleasure, moral edification, or religious enlightenment’:59 on the
contrary, the travelling of medical verses, incorporating moral and devotional themes,
with religious, philosophical or literary texts strongly suggests a dissolving of the
boundaries between information, edification and entertainment. It is appropriate, then,
to see a reader like Chaucer sharing the same kinds of texts as medical practitioners
such as John Crophill or John Arderne and locating a diversity of interests and concerns
in them.
58
London, BL Royal MS 12 E XVI. For the reference to John Somer, see Treatise on
the Astrolabe, ‘Preface’, 85.
59
Monica Green, Women’s Healthcare, p.189.
304
Medical Satire and Moral Authority
As mentioned above, a critical consensus has developed which understands Chaucerian
medicine overwhelmingly in terms of Chaucer’s satirical expressions against medical
practice. Yet an analysis of his representations of medical practitioners reveals that
whilst they are invested in anti-medical satirical discourse, they are not exclusively so.
Such discourse certainly was an abiding feature of depictions of medical practitioners in
late medieval culture: examples range from the inclusion of a charlatan physician in the
fifteenth-century miracle play, the Croxton Play of the Sacrament, to the variety of
medical practitioners illustrated as apes and other animals, typically examining a urine
flask, in illuminated manuscripts.60 Indeed, the Italian humanist tradition that helped to
develop and spread knowledge of scholastic medicine throughout Europe was not
without its own criticisms of physicians, notably in Petrarch’s (d.1374) polemic against
the ‘false rhetoric’ of physicians in his Invectiva contra medicum, or Invective against
Medical Practitioners.61 Such popular criticisms emerged from the specific nature of
the patient-practitioner relationship involving the practitioner’s specialist and privileged
knowledge of the patient’s ailing body, his intervention (sometimes involving the
infliction of pain) in the interests of returning that body to health and his reception of
60
See, for example, an illustration of an ape physician, with urinal jar, treating a sow in
a marginal illustration for the Romance of Alexander in Oxford, Bodleian Library, MS
Bodley 264, Part I, f.168. The physician who is called upon to cure Christina the
Astonishing, discussed in chapter three of this thesis, can also be seen in terms of such
satire. See also Voigts, ‘Herbs and Herbal Healing’, pp.107-52. The Croxton play is
analysed in the conclusion of this thesis.
61
See Getz, Medicine in the English Middle Ages, p.87.
305
payment for his ‘services’. The importance of trust to this delicate synergy and the
patient’s intrinsic vulnerability (and, no doubt, to some extent, fraudulent practices on
the part of practitioners) resulted in accusations of self-interest and a widespread
cynicism towards medical practitioners; although it is important to note that this
corresponded with the successful establishment of the profession. The insistence on the
importance of moral rectitude and professional integrity in the deontological sections of
medical treatises may also have been partly a means of addressing the cynicism towards
practitioners.
The argument of Chaucer’s condemnatory orientation towards medical
practitioners focuses on the description of the Doctor of Physic in the ‘General
Prologue’ of the Canterbury Tales, and its outline of a practitioner who has immersed
himself in the study of medicine but has read little of the Bible.62 This emphasis on
secular learning is compounded with the Physician’s other material interests: his
expensive apparel and his love of gold. It is suggested that he is able to indulge in his
materialism through the professional opportunities afforded by pestilence, or plague:
In sangwyn and in pers he clad was al,
Lyned with taffata and with sendal.
And yet he was but esy of dispence;
He kepte that he wan in pestilence.
For gold in phisik is a cordial,
Therefore he lovede gold in special (I, 439-44).
The last couplet here conflates the medicinal use of gold as a stimulant and the
Physician’s self-serving interests. He is also described in superlative terms as
unparalleled in his field: ‘In al this world ne was ther noon hym lik,/ To speke of phisik
and of surgerye’ (I, 412-13) Yet, the praise is undercut by its privileging of speech over
62
‘General Prologue’, The Canterbury Tales, RC, I, 438.
306
practice.63
These lines clearly participate in the genre of anti-medical satire. Whilst critics
have debated the extent to which the passage as a whole is to be read satirically, the
consensus is that Chaucer presents the Physician as well-read and knowledgeable, but
employs satire to reveal his self-interested and morally dissolute characteristics.64
Morrissey adds another dimension to this by claiming that Chaucer presents the
Physician as the best according to contemporary medical standards but that he
(Chaucer) ‘appears to have considered these standards […], to be lamentably poor’.65
63
Huling Ussery has argued that this statement is meant in a non-ironic way; he reads it
as meaning that if one is to speak of physic and surgery, there is none comparable to the
Physician. But, I believe that the syntax is ambiguous enough to support an ironic
reading. See Ussery, Chaucer’s Physician, p.95, and Helen Cooper, The Canterbury
Tales, Oxford Guides to Chaucer (Oxford and New York: Oxford University Press,
1996), p.49. Marion Turner describes how terms of praise can function satirically in the
‘General Prologue’: thus the ‘wanton friar is ‘vertous’, the corrupted Pardoner ‘gentil’,
the adulterous Wife of Bath ‘a worthy womman’’. See Turner, Chaucerian Conflict:
Languages of Antagonism in late Fourteenth-Century London (Oxford and New York:
Oxford University Press, 2007) p.132.
64
For variations of this perspective, see Margaret Hallissy, A Companion to Chaucer’s
Canterbury Tales (Westport, CT: Greenwood Press, 1995), p.41; Curry, Mediaeval
Sciences, pp.3-36; Ussery, Chaucer’s Physician, pp.91-100. Carol Rawcliffe argues that
the Physician (and, by extension, medical practice) is presented in largely positive
terms. See Rawcliffe, ‘Doctor of Physic’, pp.303-12.
65
Morrissey, ‘“Termes of Phisik”’, p.49.
307
The argument that Chaucer uses the figure of the Physician to demonstrate an inept
practitioner or to attack medical practice itself persists in criticism of the ‘Physician’s
Tale’. This is a story Chaucer took from the Roman historian Livy (59 BCE-17 CE)
concerning the attempted abduction by a judge of a virgin, and her subsequent death at
the hands of her father in order to protect her chastity. A great deal of criticism has
focused on the reasons why Chaucer would have had the Physician tell a story that had
so tenuous a relationship to his profession: one camp argues that it is a means for the
Physician to advertise himself as a moral person;66 another claims that the narrative’s
unevenness and moral uncertainty allows Chaucer to portray the Physician as an inept
storyteller, thereby condemning him as a poor example of his profession; this view is
predicated on the importance attributed to rhetoric in late medieval medical etiquette.67
However, such criticism risks a superimposition of modern perspectives of
characterisation onto late medieval writing. What emerges is either an idea of the
characters in the Canterbury Tales having their own extra-textual autonomous existence
(allowing one to propose, for instance, that Chaucer condemned the Physician), or a
criticism in which narrative clues are marshalled in order to speculate on Chaucer’s
66
See Daniel Kempton, ‘The “Physician's Tale”: The Doctor of Physic's Diplomatic
Cure’, in The Chaucer Review, 19:1 (1984), 24-38; Kirk. L. Smith, ‘False Care and the
Canterbury Cure’, pp.61-81; Ussery, Chaucer’s Physician, pp.120-127.
67
See Elaine E. Whitaker, ‘John of Arderne and Chaucer’s Physician’, ANQ, 8:1
(1995), 3-8; Emerson Brown, Jr., ‘What is Chaucer Doing with the Physician and His
Tale?’, Philological Quarterly, 60:2 (1981), 129-150 (p.130); Thomas B. Hanson,
‘Chaucer’s Physician as Storyteller and Moralizer’, The Chaucer Review, 7:2 (1972),
132-9.
308
authorial intentions.68 The debate is consequentially reduced to whether Chaucer
condemned medicine or not. A more fruitful insight into the configuration of the
physician may be reached by undertaking readings of the text based on the formal
features of the language, the generic or discursive modalities it engages with and its
inter-textual significance. This allows the identification of anti-medical discourse
without having to make judgements on whether Chaucer was for or against medicine
(an unanswerable question), or without foreclosing the myriad other ways in which
medicine is invoked in Chaucer’s corpus. Thus, in this sense, the anti-medical satire of
the description of the Physician in the ‘General Prologue’ can be seen to blend with
elements of scholastic medical discourse, exemplified by the reference to medical
authorities, as well as an elucidation of the qualities of the ideal and consummate
medical practitioner. The figure that emerges, then, is a textual composite of the satirical
tradition and the scholastic one; from this perspective, the representation of the
Physician can be seen to incorporate the privileging (and implicit questioning) of
genealogies of knowledge, the tensions and correspondences between Scripture and the
scholastic text, disquietude relating to the exchange of health for money and the
merging of diverse fields of learning.
One of the discursive strands invoked in the ‘General Prologue’s description of
the physician is that of medical deontology. The outlining of his comprehensive
knowledge, measurable diet and deferment to medical authorities (even if satirically
imbued) evokes the kind of qualities recommended in the prefaces of medical treatises,
and their insistence upon the practitioner’s professional legitimacy and moral
68
Emerson Brown Jr., for instance, states that ‘Chaucer the poet obviously criticizes the
Physician for his arrogance and greed’. See Brown, ‘What is Chaucer Doing?’, p.30.
309
investiture. This idea of medical practitioners exemplifying moral authority
(antithethical to their satirical representations) is foregrounded in Chaucer’s other
extended reference to medical practitioners, in the ‘Tale of Melibee’. The tale, given to
Chaucer’s persona, the pilgrim Geoffrey, in the Canterbury Tales, is a translation of the
Liber consolationis et consilii by the Italian jurist Albertanus of Brescia (c.1193c.1270).69 In the tale, Melibee, whose enemies have broken into his house and attacked
his wife and daughter, begins his quest for justice and redress by summoning ‘a greet
congregacion of folk’ (VII,1003), including a group of physicians and surgeons, law
advocates and other neighbours and friends.70
When asked their opinions on how Melibee should proceed, one of the surgeons
69
William Askins, ‘The Tale of Melibee’, in Sources and Analogues, ed. by Robert M.
Correale and Mary Hamel, Vol. I, pp.321-30 (p.321). See also Angus Graham,
‘Albertanus of Brescia: A Preliminary Census of Vernacular Manuscripts’, Studi
Medievali, 41 (2000), 891-924; J. Burke Severs, ‘The Source of Chaucer’s Melibeus’,
PMLA, 50 (1935), 92-99. The widespread popularity of Albertanus’s work is evidenced
by the more than three hundred extant copies of his work (thirteen contemporary
English manuscripts containing Latin copies of his work are known). See Askins, ‘Tale
of Melibee’, p.330. There is evidence that Chaucer used the text to inform the
‘Manciple’s’ and ‘Merchant’s Tales’ too, and scribes who copied the Canterbury Tales
glossed all three tales with quotations from Albertano’s Latin text. See Askins, ‘Tale of
Melibee’, p.321. It is also likely that Chaucer knew the text through its French
translation by a Dominican friar, Renaud de Louens (fl.1336), entitled Le Livre de
Melibee et Prudence.
70
This episode also features in Albertanus’s text.
310
begins by giving a statement of their professional intent (a statement that is similar to
professions often made in the prologues of surgical treatises and found in many versions
of the Hippocratic Oath):71
‘Sire’, quod he, ‘as to us surgiens aperteneth that we do to every wight the beste
that we kan, where as we been withholde, and to oure pacientz that we do no
damage,/ wherfore it happeth many tyme and ofte that whan twey men han
everich wounded oother, oon same surgien heeleth hem bothe; […] But certes, as
to the warisshynge of youre doghter, al be it so that she perilously be wounded,
we shullen do so ententif bisynesse fro day to nyght that with the grace of God she
shal be hool and sound as soone as is possible’ (VII, 1012-15).
This pronouncement brings together key features comprising the ideal behaviour of
surgeons as advocated in late medieval deontology: the practitioners promise to proceed
without favour to any party, but to be willing to provide assistance to both sides of a
faction; they vow to try to help to cure the patient and to seek to avoid doing harm; their
assurances that they will restore health to Melibee’s daughter accords with the
deontological emphasis on the surgeon’s positive and optimistic language; finally, their
invocation of God’s grace is a standard element of a surgeon’s conception of his
practice and its divine basis.
After all of Melibee’s advisors have spoken, Dame Prudence, Melibee’s wife and
chief advisor, characterised in the text in terms of a ‘pragmatic didacticism’, gives her
judgement on the various pieces of advice Melibee has received.72 She condemns most
of it on the basis that it encourages vengeance; but she commends the surgeons’
71
On the Hippocratic Oath, see Galvao-Sobrinho, ‘Hippocratic Ideals’, pp.438-55, and
Carrick, Medical Ethics, pp.83-107.
72
Patricia DeMarco, ‘Violence, Law, and Ciceronian Ethics in Chaucer’s Tale of
Melibee’, Studies in the Age of Chaucer, 30 (2008), 125-169 (p.126).
311
perspectives: ‘right so rede I that they been heighly and sovereynly gerdoned [rewarded]
for hir noble speche’ (VII, 1271).73 The surgeons are thus represented in the tale in
terms of their adherence to professional standards underscored by an authoritative
ethical tradition.74 They are commended by Prudence because their practice of social
harmony and equanimity arises specifically from their diligence in applying their craft.
Stephen Yeager notes, in this wise, that Prudence recommends the practitioners as
‘freendes’ (VII, 1273) to Melibee because they have promised to treat their daughter,
Sophie, to the best of their ability, and that this acceptance ‘explicitly links the quality
of their friendship to the application of their craft’.75 It is not that the practitioners
display particular empathy to either Sophie or Melibee, but rather that their commitment
73
On the importance of speech as a means of productive deliberation in the tale, see
Stephen G. Moore, ‘Apply Yourself: Learning While Reading the Tale of Melibee’, The
Chaucer Review, 38:1 (2003), 83-97. See also Mari Pakkala-Weckström, ‘Prudence and
the Power of Persuasion: Language and Maistrie in the Tale of Melibee’, The Chaucer
Review, 35:4 (2001), 399-412.
74
Although the physicians give similar advice, they crucially add ‘“that right as
maladies been cured by hir contraries, right so shul men warisshe werre by vengaunce”’
(VII, 1017). Prudence corrects this in her summation by countering that ‘“wikkednesse
is nat contrarie to wickedness […] but certes, wikkednesse shal be warisshed by
goodnesse”’ (VII, 1283-89). The physicians, like Melibee and contrary to the surgeons,
misunderstand the implications of their own advice. However, they are not explicitly
criticised for this.
75
Stephen Yeager, ‘Chaucer’s Prudent Poetics: Allegory, the Tale of Melibee, and the
Frame Narrative to the Canterbury Tales’, The Chaucer Review, 48:3 ( 2014), 307-321
(p.310).
312
to their duty impels them to act in ways consistent with the evenness of justice. The
language the surgeons adopt when making their promises to Melibee - ‘apperteneth’
(denoting a privilege or a duty), ‘pertinent’ (suitable) and ‘ententif bisynesse’
(diligence) – underscores this commitment. On the tale’s allegorical level, the surgeons
are making a commitment to restore sophia, or wisdom, thereby making an implicit link
between medical practice or knowledge and wisdom.76 In a tale that advances
pragmatism and prudent action, the surgeons epitomise virtuous behaviour, and the fact
that they are called upon as judicial authorities implies social acceptance of their virtues
in this regard.77 The ideal perspective in which the surgeons are described in ‘Melibee’
counters arguments of the exclusivity of Chaucer’s satirical treatment of medical
practitioners. It demonstrates that, even though the depiction of the Physician includes
an exposition of the pecuniary and self-aggrandising orientation of medical
76
For allegory in the tale, see Jamie Taylor, ‘Chaucer’s Tale of Melibee and the Failure
of Allegory’, Exemplaria, 21:1 (2009), 83–101, and Helen Cooper, The Structure of the
Canterbury Tales (London: Duckworth, 1983), pp.174–75.
77
Kathleen E. Kennedy points out that ‘wise men’ were often maintained as legal
counsel. See Kennedy, ‘Maintaining Love through Accord in the Tale of Melibee’, The
Chaucer Review, 39:2 (2004), 165-176 (p.169). Patricia DeMarco argues that the tale
offers ‘a means of satisfying the practical ends of social existence, especially the drive
to satisfy honor, that is both pragmatic and ethically rigorous’. See DeMarco, ‘Violence,
Law, and Ciceronian Ethics’, p.128. On pragmatics and ethics in ‘Melibee’, see David
Aers, ‘Chaucer’s Tale of Melibee: Whose Virtues?’, in Medieval Literature and
Historical Inquiry: Essays in Honour of Derek Pearsall, ed. by David Aers (Cambridge:
D.S Brewer, 2000), pp.69–81.
313
practitioners, Chaucer’s works also attest to the encasement of medical practice within
authoritative and philosophical traditions.
Medical Theory and Philosophy
The link between medicine and philosophy is one that extended back to Hippocrates and
Galen. Galen’s adoption of an Aristotelian ontology in locating universal patterns in
particular bodily organs or systems was fundamental to the subsequent development of
a deductive, integrated medicine.78 The theory of the non-naturals incorporated all
aspects of one’s being and existence within the purview of humoral theory and the overarching elemental and cosmic orders. Chaucer’s employment of medical language to
engage with themes such as virtuous living, happiness, fortune and sin and salvation
operates in terms of such interconnections. The Consolation of Philosophy by the sixthcentury Roman philosopher Boethius (c.480-c.524) constitutes a major source for
Chaucer’s literary treatment of medicine in the way that it employs medical language
and concepts in promoting a stoical or moderate mode of living. The Consolation,
translated by Chaucer as Boece, concerning its protagonist’s dialogue with the
allegorical figure of Lady Philosophy on the vagaries of fortune, consistently employs
images of sickness and healing. The imprisoned or exiled Boethius meditating on his
bad fortune is visited first by poetical muses who offer respite. However, their comfort
is deemed false by Lady Philosophy who appears and asks,
78
Philip J. van Eijk, ‘Aristotle! What a thing for you to say!’, Galen’s Engagement with
Aristotle and Aristotelians’, in Galen and the World of Knowledge, ed. by Christopher
Gill, Tim Whitmarsh and John Wilkins (Cambridge and New York: Cambridge
University Press, 2009), pp.261-81.
314
‘Who’, quat sche, ‘hath suffred aprochen to this sike man thise comune
strompettis of swich a place that men clepen the theatre? The whiche nat oonly ne
asswagen noght his sorwes with none remedies, but their wolden fedyn and
noryssen hym with sweete venym’ (Boece, I, Prosa 1, 47-53).
Boece’s sickness is connected to his ‘sorwe’ due to the physical effects of his ageing in
confinement: these include his ‘slakke skyn’ and ‘emptid body’ (I, Metrum 1, 17).
Philosophy later qualifies this by suggesting that he ‘is fallen into a litargye,
whiche that is a comune seknesse to hertes that been desceyved’ (I, Prosa 2, 19-21). For
Philosophy, the poetical muses will distract Boece and offer only false remedies that are
ultimately harmful. Typical of the medieval deployment of medical imagery, there is
slippage between the literal (Boece is sick) and the metaphorical (the muses ‘noryssen’
Boece with ‘venym’); this is consolidated subsequently when Boece refers to
Philosophy as his ‘fisycien’ (I, Prosa 3, 4). Philosophy tells him that the cure she offers
is that of her own muses, the ‘noteful sciences’ (I, Prosa 1, 73), and that this medicine
will be administered in stages:
‘But for that many [turbacions] of affeccions han assailed the, and sorwe and ire
and wepynge todrawen the diversely, as thou art now feble of thought, myghtyere
remedies ne schullen noght yit touchen the. For wyche we wol usen somdel
lyghtere medicynes, so that thilke passiouns that ben waxen hard in swellynge by
perturbacions flowynge into thy thought, mowen waxen esy and softe to
resceyven the strengthe of a more myghty and more egre medicyne, by an esyere
touchynge’ (I, Prosa 5, 68-78).
Catherine Brown Tkacz notes how this and other passage in Boece highlight Stoical
ideas of a progressive moral sickness comprising intensifying degrees of emotional
315
upheaval.79 But the language that describes the ‘passiouns’ in material terms (hardening,
swelling and flowing), as well as the logic of calibrating ‘medicyne’ depending on the
state of the patient, also owes much to Galenic humoral theory. Boece’s sickness can be
understood in terms of the non-naturals and the concept of humoral imbalance affecting
the mind and emotions. In this way, the allegorical narrative of Boece sustains
metaphorical readings of Lady Philosophy’s ontological ‘medicyne’ as well as literal
interpretations based upon medical ideas, that measured and virtuous language can itself
be health-inducing. This idea of medicinable rhetoric is evoked in Philosophy’s
encouragement to Boece:
‘But now is tyme that thou drynke and ataste some softe and delitable thynges, so
that whanne thei ben entred withynne the, it mowe maken wey to strengere
drynkes of medycines. Com now forth, therfore, the suasyoun of swetnesse
rethorien’ (II, Prosa 1, 37-41).
Chaucer transmits this Boethian configuration of medicine into his wider corpus,
typically employing it as proverbial wisdom and thereby enhancing its (avowed)
legitimacy and authenticity.80 This can be seen in Troilus and Criseyde when Pandarus
exhorts Troilus to reveal the object of his affections (to enable him (Pandarus) to advise
79
Catherine Brown Tkacz, ‘“Troilus, the Syke”: Boethian Medical Imagery in
Chaucer's Troilus and Criseyde’, Forum, 24:3 (1983), 3-12 (p.4). See also E. Vernon
Arnold, Roman Stoicism: Being Lectures on the History of the Stoic Philosophy
(London: Oxford University Press, 1911), pp.238-43.
80
See Tkacz, ‘“Troilus, the Syke”’, pp.3-12; John P. McCall, ‘Five-Book Structure in
Chaucer’s Troilus’, Modern Language Quarterly, 23 (1962), 297-308; William Watts,
‘Verray Felicitee Parfit and the Development of Chaucer’s Philosophical Language’,
The Chaucer Review, 43:3 (2009), 260-281.
316
him better): ‘For whoso list have helyng of his leche, / To hym byhoveth first unwre his
wownde’ (I, 857-8). Again, the same hinging between literal and figurative senses is
brought into play here: Troilus is suffering from an emotional or melancholic sickness
and Pandarus fulfils a similar advisory role to Lady Philosophy (though it is arguably
inept and self-serving) in the text. The ‘Parson’s Tale’ also uses the image of medicine
as a way of conceiving of spiritual development: ‘Certes, thanne is love the medicine
that casteth out the venym of Envye fro mannes herte’ (X, 530). Chaucer’s use of such
proverbs emphasises the applicability of medical knowledge and theory to variable
contexts. It forms part of his employment of technical vocabularies, in treatises such as
the ‘Tale of Melibee’ and the ‘Parson’s Tale’, as a means to rehearse moral and spiritual
concepts. This reflects the broader incorporation of practical knowledge within literary
and religious contexts.
The shared formal qualities of medical, penitential or legal treatises, with their
mutual incorporation of classical and scriptural authoritative knowledge, problematise
modern perspectives that would regard them as wholly discrete fields of knowledge.
The ‘Tale of Melibee’, a compilatio made up of various scraps of classical knowledge
advancing the arguments of its allegorical characters, parallels John Arderne’s preface
to his treatise on anal fistula, drawing on the proverbs and maxims of a host of classical
philosophers and Scripture.81 Arderne, in advising his surgeon-reader on how to placate
anxious patients, draws on Philosophy’s teaching about the vagaries of Fortune to
81
A.J. Minnis argues that compilatio allowed medieval writers and compilers to
appropriate or manipulate their sources according to their own agenda. See Minnis,
Medieval Theory of Authorship, pp.97–101 and 191–210. For the ‘Tale of Melibee’ as
compilatio, see Amanda Walling, ‘“In Hir Tellyng Difference”: Gender, Authority, and
Interpretation in the Tale of Melibee’, The Chaucer Review, 40:2 (2005), 163-181.
317
Boethius: ‘ffor Boecius seiþ […], “He is noȝt worthi of þe point of swetnes that kan noȝt
be lymed with greuyng of bitternes. ffor why; a strong medicine answerith to a strong
sekenes”’.82 The corresponding passage in Chaucer’s translation of Boece, eliding the
aphorism of the strong medicine, reads: ‘The swetnesse of mannes welefulnesse is
spraynd with many bitternesses’ (II, Prosa 4, 118-9). Another proverbial reference to
bitter medications in Book III of Troilus and Criseyde asserts the same meaning:
O, sooth is seyd, that heled for to be
As of a fevre or other gret siknesse,
Men moste drynke, as men may ofte se,
Ful bittre drynke (III, 1212-15).
Such intertextual correspondences indicate the way that the same authority can be
shared across romance, philosophical and surgical literature. If Boethian medicine is
employed figuratively or to denote moral sickness here (and as shown above, this is not
exclusively so), its use in Arderne’s treatise shows how it can be equally appropriated to
apply to the surgical setting. Chaucer’s persistent engagement with medical images,
knowledge and theory exemplifies medieval medicine’s amenability to the exploration
of diverse themes, but also affirms its implication within the constitution of an overarching and integrated order.
Practical Medicine and Obfuscating Terminology
The diffuse nature of Chaucerian medicine reflects an exploratory and abiding
engagement with the physical and spiritual potentialities of medical language, but also
its attendant disconcerting implications. The iteration by Church authorities of a
82
Arderne, Treatises, p.7.
318
hierarchy where divine authority is privileged over medical healing was consistently
beset by the ineluctable insinuation of medical discourse within a wide variety of
writings. Its accessibility to the hidden recesses of the ailing body offered spiritual and
moral authors ways of conceiving of the invisible soul. But the claims to authority by
medical practitioners, along with their penetrating knowledge of the body, could
simultaneously provoke caution and suspicion. This reaches its intensification in the
imbalances central to the medical encounter, bringing together the knowing expert and
the suffering, submissive subject.83 Julie Orlemanski argues that the ambivalence
towards medical practice was related to the way that the explosion of medical treatises
in late medieval England carried ‘a broad literate recognition of the possibilities of
language to make the contingent substance of one’s own and others’ bodies legible and
manipulable’.84 However, the technological articulation of the medical subject is itself
rhetorically constituted, as this thesis argues.85 The presence of poetical or rhetorical
qualities in practical writings, or fachliteratur, reconstitutes such works beyond their
ostensible utilitarian function. 86 A literary author such as Chaucer provides an
interesting point of reflection on the relation between literary qualities and practical
writing: this is not just because he wrote a quintessential example of this genre, A
83
Julie Orlemanski, ‘Physiognomy and Otiose Practicality’, Exemplaria, 23:2 (2011),
194–218 (p.201).
84
Orlemanski, ‘Physiognomy’, p.200.
85
See the analysis of John Arderne’s use of rhetoric in chapter one and the exploration
of enunciations of the institutional subject in chapter three.
86
Lisa H. Cooper makes this argument in ‘The Poetics of Practicality’, in Oxford
Twenty-First Century Approaches to Literature: Middle English, ed. by Paul Strohm
(Oxford and New York: Oxford University Press, 2007), pp.491-505.
319
Treatise on the Astrolabe, but moreover because his writings in general absorb many of
the elements of practical literature. Chaucer’s incorporation of medical discourse is not
just characterised by transmission; he also probes its authoritative and absolutist
rhetoric. This feature offers a more nuanced way to understand the place of anti-medical
satire within Chaucer’s oeuvre, by conceiving of it not as a dismissal of medicine or
medical practitioners but as emerging from a literary engagement with both the power
and fallibility of medical language.
Some of the disturbing elements of medical discourse are investigated in the
Physician-Pardoner link in Fragment VI of the Canterbury Tales. The link features the
reaction of the Host, Harry Baillie, to the ‘Physician’s Tale’. He mockingly appropriates
the pathos of the tale and employs it to describe his own response:87
[…] I kan nat speke in terme;
But wel I woot thou doost myn herte to erme,
That I almoost have caught a cardynacle.
By corpus bones! but I have triacle,
Or elles a draughte of moyste and corny ale,
Or but I heere anon a myrie tale,
Myn herte is lost for pitee of this mayde (VI, 311-317).
The hyberbolic nature of the Host’s response to the daughter’s death in the tale, with his
mention of heart pains, his swearing and his attempts at self-treatment, relates
specifically to the Physician’s profession, and makes an implicit link between his role as
practitioner and his ability to convey an appropriate narrative. In contrast to the modern
critical preoccupation with the unevenness or non-edifying aspects of the tale (referred
87
See Angus Fletcher, ‘The Sentencing of Virginia in the “Physician's Tale”’, in The
Chaucer Review, 34:3 (2000), 300-308. Fletcher discusses the tension between the
Host’s authority and responsibility for determining the sententia, or meaning, of the text
and informal modes of reading which conflict with the Host’s.
320
to above), it is its elements of pathos and melancholy that Harry Baillie addresses here.
Certainly, the passage achieves comic affect through his paralipsis followed by his
attempt to use medical terminology foundering (perhaps intentionally) on the
malapropism ‘cardynacle’, a term that would usually be ‘cardiacle’, a heart disorder.
Jake Walsh Morrissey points to the Host’s attempt to use terminology as a literary
reflection of the circulation of scholastic knowledge in vernacular medical works, and
Harry’s identification of possible remedies, a treacle and ale, for his putative condition
does add to the representation of a character with some familiarity of curative
strategies.88 But the inclusion of the malapropism also registers the overlapping of
religious (‘cardinal’) and medical (‘cardiacle’) languages, thus suggesting that Harry
cannot be quite sure which epistemic field the term he employs belongs in. This
confusion works, then, as a comic instance of the kind of discursive intertwining
regularly practiced by Chaucer in his writings. The conflation draws attention to the
language of medicine, and to the fact that it comprises a vocabulary through which one
may order subjective experience and identify internal conditions and their treatment.
The circulation of medical literature such as health regimens allowed for just such selfdiagnosis and it is telling that the Host’s response to his affected illness is to suggest
various treatments. Nonetheless, his negation and halting articulation of such ‘termes’
underlines the way that medical language could also instigate uncertainty by its
application of nebulous terminology to the experiences and sensations of suffering and
pain. Such concerns can also be seen in the more general terms of late medieval theories
88
Morrissey, ‘“Termes of Phisik”’, pp.76-80. For the widespread dissemination of
medical information, see Jones, ‘Information and Science’, p.110.
321
of language decline and ‘the Ovidian association of plain speaking and innocent
discourse with the Golden Age, and of rhetorical artifice with the decadent present’.89
Another dimension can thus be added to Chaucer’s satirical engagement with
medicine: it reflects this ambivalence of the desire for a language that could fix, order
and identify the experiences of illness and suffering and a suspicion of, and an ensuing
attempt to distance, its rhetorical, artificial nature. This ambivalence is suggested in the
Host’s reference to the Physician in terms of the instruments of his trade:
I pray to God so save thy gentil cors,
And eek thyne urynals and thy jurdones,
Thyn ypocras, and eek thy galiones,
And every boyste ful of thy letuarie;
God blesse hem, and oure lady Seinte Marie!
So moot I theen, thou art a propre man,
And lyk a prelat (VI, 304-310).
The listing of the materials used by and associated with medical practitioners
emphasises medicine in terms of its applicability. It provides a practical complement to
the ‘General Prologue’s’ convening of medical authorities, underlining medical theory
and learning. Indeed, this symmetry is made explicit with the retention of Hippocrates
and Galen in this list, this time as, respectively, a medicine and a jar. In this sense, the
instruments might work as signifiers of expertise and knowledgeable authority. But, in
tandem with the general tone of mockery and playfulness in this passage, Harry hints
instead at their inadequacy. Despite the onset of his supposed ‘cardynacle’, the
instruments, like the Physician’s employment of a dispiriting tale, index the limitations
and emptiness of medical knowledge rather than their curative power. This resonates
89
John M. Fyler, Language and the Declining World in Chaucer, Dante, and Jean de
Meun (Cambridge and New York: Cambridge University Press, 2010), p.156.
322
with the foregrounding of urinals in myriad late medieval images lampooning medical
practitioners;90 although as both Huling Ussery and Lorrayne Baird have noted the
urinal could just as often be a symbol of physicians’ skill and knowledge. 91 Although
the mocking tone evident in the Host’s list serves to undermine the use of these
instruments, their incorporation in his extended swear and his invocation to God and
Mary to protect them recasts them as sacred-like objects. That God should be prayed to
in order to protect the materials that allow the Physician to diagnose and treat illnesses
suggests (however flippantly) a connection, as well as a tension, between the
Physician’s remedial efforts and divine intervention. Similarly, the suggestion by the
Host that the Physician is ‘lyk a prelat’ alludes to the shared characteristics between
medical and religious healers, characteristics emphasised by so many medical writers to
bolster their authority.92
90
Some illustrations of Reynard the Fox in late medieval manuscripts portrayed him as
a physician tricking others by examining their urine and thereby demonstrating
knowledge he does not possess. See Elaine C. Block and Kenneth Varty, ‘Choir-Stall
Carvings of Reynard and Other Foxes’, in Reynard the Fox: Social Engagement and
Cultural Metamorphoses in the Beast Epic from the Middle Ages to the Present, ed. by
Kenneth Varty (Oxford and New York: Berghahn, 2000), pp.125-62. Uroscopy is also
lampooned in the Croxton Play of the Sacrament, studied in the following chapter.
91
See Ussery, Chaucer’s Physician, p.116, and Lorrayne T. Baird, ‘The Physician’s
“urynals and jurdones”: Urine and Uroscopy in Medieval Medicine and Literature’, in
Fifteenth-Century Studies, ed. by R. Mermier and Edelgard E. DuBruck, Vol. II (Ann
Arbor, Michigan, 1979), pp.1-8 (p.1).
92
Although many university-trained physicians in England were clerics, Chaucer’s
Physician is not explicitly presented as one. The gradual secularisation of medical
323
The (derisive) implication that the Physician’s materials are both redundant and
invested with sacred-like powers links them with the Pardoner’s relics, the teller of the
following tale in the fragment. Chaucer’s description of the Pardoner in the ‘General
Prologue’, unlike that of the Physician, carries the unambiguous declaration of his
deceitful use of his dubious relics:
For in his male he hadde a pilwe-beer,
Which that he seyde was Oure Lady veyl;
He seyde he hadde a gobet of the seyl
That Seint Peter hadde, whan that he wente
Upon the see, til Jhesu Crist hym hente.
He hadde a croys of latoun ful of stones,
And in a glas he hadde pigges bones (I, 694-700)
Like the Physician’s containers and medicines, the Pardoner’s relics are meant to help
cure the sick or protect against illnesses, but they work exclusively through their
association with Christ or one of the saints. The Pardoner’s falsification is underlined by
the ludicrous nature of some of the things he passes off for relics: he claims, for
instance, that a pillow-case is the Virgin Mary’s veil and masquerades pigs’ bones as
those of a saint. What imparts value to these relics is the speech of the Pardoner and the
containers that they are placed in.93 Later in the ‘Pardoner’s Prologue’, he will explain
his art of deceit: ‘Thanne shewe I forth my longe cristal stones, / Ycrammed ful of
cloutes and of bones’ (VI, 347-348), emphasising again the discrepancy between the
material or disposable rags and bones and their sacred investiture through duplicitous
language.
practice over the late medieval period does not make this untypical. See Rawcliffe,
‘Doctor of Physic’, pp.301-3.
93
See Robyn Malo, ‘The Pardoner’s Relics (And why they matter the most)’, The
Chaucer Review, 43:1 (2008), 82-102 (pp.88-89).
324
The containers that hold these items also lend them worth: the glass that holds the
pigs’ bones exerts a transformative effect on these otherwise useless things; the stones
placed inside the cross suggest that it contains relics, and that it is made of gold rather
than base ‘latoun’, an alloy of copper and tin.94 The Physician’s containers resemble
these reliquaries in the sense that they also lend value or worth to the materials they
contain. Just as the dead animal matter placed inside a glass reliquary by the Pardoner
transforms its nature, the human excreta in the Physician’s urinals, transforms urine
from waste into a diagnostic tool that can give information on a patient’s illness. The
fact that one may see the bones or urine in their containers suggests that their power
resides in their making visible what is usually hidden inside the body. This
transformation of internal bodily viscera or dead objects into something that is visible,
and yet out of immediate reach (being encased in glass), adds to their value as sacred or
arcane objects. There is thus a mutual insistence on the Pardoner’s relics and the
Physician’s instruments, as both powerful and empty: they are transformed through
language (the Pardoner’s deceit, the Physician’s prognosis) into objects that possess
power to engender bodily health. However, the satire with which they are described
undercuts this power by suggesting their limited use beyond language and spectacle.
These also bear similarities to those of another ‘falsifier’ in the Canterbury Tales, the
Canon’s Yeoman’s list of alchemical instruments in his prologue are likewise given
(false) potency through deceptive language.95
94
‘latoun, n. and adj.’, MED http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED24786 [accessed 11 December 2014].
95
The fact that this list includes ‘urynales’ (VIII, 792) underscores the shared practices
between these various disciplines.
325
The representation of the Physician’s urinals and jars, then, are textual signs that
represent not so much the materials themselves, but instead constitutes them in terms of
various accretions of significations. Whereas the display of such materials could often
signify medical authority and expertise in late medieval culture, here, in common with
other satirical treatments, they are also ambiguously associated with the questioning or
lampooning of medical authority. An important aspect of the way the material-as-sign is
foregrounded in this instance is its formulation through list-making. Listing offers a
means of ordering and fixing knowledge as well as enabling its display.96 Chaucer’s
many lists throughout his writings tend to connect this ordering with the idea of
authority, although this often provides an opportunity to question that authority.97 For
example, the Physician’s knowledge in the ‘General Prologue’ is outlined through his
reading of multiple medical authority figures; yet, this authority is brought into question
through supplanting it with a higher biblical authority. Moreover, it is in the poetic
appropriation of the list where its order and authoritative status is most open to question
and ‘where the truth is unstable and always potentially conducive to infection’.98
Therefore, whilst Chaucerian medicine registers attempts to appropriate medical
96
Valentina Izmirlieva, All the Names of the Lord: Lists, Mysticism, and Magic
(Chicago and London: University of Chicago Press, 2008), pp.6-7.
97
See Lara Ruffolo, ‘Literary Authority and the Lists of Chaucer’s “House of Fame”:
Destruction and Definition through Proliferation’, The Chaucer Review, 27:4 (1993),
325-341; Stephen A. Barney, ‘Chaucer’s Lists’, in The Wisdom of Poetry: Essays in
Early English Literature in Honour of Morton W. Bloomfield, Larry D. Benson and
Siegfried Wenzel (Kalamazoo, MI: Medieval Institute Publications, 1982), pp.189-223.
98
Richard Allen Shoaf, Chaucer’s Body: The Anxiety of Circulation in the Canterbury
Tales (Gainesville, FL: University of Florida Press, 2001), p.60.
326
knowledge and attest to its power and amenability, it also probes its all-encompassing
claims through foregrounding its linguistic or rhetorical basis.
Melancholy and the Poetic Subject
I have shown that the diffuse nature of medicine in Chaucer’s corpus makes it
susceptible to a host of literary strategies: it is subject to satire; medical theory can be
used to inform philosophical positions; it can signify authority and truth and,
conversely, their instability. In this final section, I consider the employment of medical
language in establishing a certain kind of poetic subject: the melancholic subject. The
various uses of the noun ‘melancholy’ are instructive in that it connoted the substance
melancholy, or black bile, a dark and dense subject and one of the four constituent
bodily humours; it also referred to the mental disorder or emotional imbalance that was
thought to derive from an excessive amount of this humour, and could also be used
more generally to refer to sorrow or gloom.99
Melancholy was associated with lovesickness through their shared symptoms but
also because excessive lovesickness was thought to trigger melancholy. Such
correspondences often led to the conflation of both conditions; however, Chaucer
distinguishes them when describing Arcite’s lovesickness in the ‘Knight’s Tale’:
99
Peter E. Portmann, ‘Melancholy in the Medieval World: The Christian, Jewish and
Muslim Traditions’, in Rufus of Ephesus: On Melancholy, ed. by Peter E. Portmann
(Tübingen: Mohr Siebeck, 2008), pp.179-96. See also entry for ‘malencolī(e. n’, MED
http://quod.lib.umich.edu/cgi/m/mec/med-idx?type=id&id=MED26645 [accessed 11
December 2014].
327
And in his geere for al the world he ferde
Nat oonly lik the loveris maladye
Of Hereos, but rather lyk manye,
Engendred of humour malencolik
Biforen, in his celle fantastik (I, 1372-6).
Here, melancholy is defined in material terms, through the formation of the humour,
melancholy, in the ‘celle fantastik’, the part of the brain that was thought to be
responsible for the imagination.100 However, both conditions are consistently referred to
and conflated throughout Chaucer’s writings and translations in texts such as the
‘Knight’s Tale’, Troilus and Criseyde, the Romaunt of the Rose and the Book of the
Duchess. They are amenable to the articulation of a particular kind of sorrowful poetic
subject, one who is overcome with emotions and, as a result, is mentally or
psychologically compromised.
The vague manner in which melancholy is often delineated in such texts work to
instantiate it as both humoral disorder and subject position; the sufferer is one who is
sick in body and in spirit, and often the cure is performed through the agency of
language. This is true of its representation in the Book of the Duchess. The text begins
with a description of the narrator’s eight-year long melancholy before proceeding to
recount a dream-vision where the narrator meets an equally melancholic ‘man in blak’
mourning the death of his wife, White. The dreamer’s melancholy is mainly described
100
John M. Hill focuses on this difference between lovesickness and melancholy in
Chaucer in ‘The “Book of the Duchess”, Melancholy, and That Eight-Year Sickness’,
The Chaucer Review, 9:1 (1974), 35-50 (p.37). It is important to bear in mind the
rhetorical functioning of this statement in the ‘Knight’s Tale’ rather than seeing it as
necessarily reflecting Chaucer’s view.
328
in terms of insomnia and is accompanied by a fear of death, which, he says, has ‘sleyn
my spirit of quyknesse’ (26). The vague nature of his condition is alluded to by his
admission of perplexity regarding its cause:
Myselven can not telle why
The sothe; but trewly, as I gesse,
I holde hit be a sicknesse
That I have suffred this eight yeer;
And yet my boote is never the ner,
For there is phisicien but oon
That may me hele; but that is don (34-40).
Although the narrator has opened the poem stating with certainty that he is affected by
melancholy, here he displays uncertainty as to whether it can be accorded the status of
an illness. All he knows is that he has no ‘boote’, or remedy, and, mysteriously, that
there is only one physician who could cure it. His confusion over whether he is sick
suggests that ‘phisicien’ may be meant metaphorically: the physician-trope is often used
in romance narratives to describe the beloved of the sufferer (later in this narrative
White is described as the Black Knight’s ‘lyves leche’ (920)) and so there may be an
implication of this here;101 it might also refer to God. More importantly, the lack of
specificity informs the general opacity attending the description of melancholy here.
When the narrator finally sleeps, he experiences a dream where he eventually
encounters the ‘man in blak’ mourning over the death of his wife.102 The focus moves
101
John M. Hill speculates that the narrator’s physician is ‘sleep’ but there is nothing
conclusively in the text to suggest this. See Hill, ‘“Book of the Duchess”’, p.43.
102
There is a good deal of evidence to suggest that the text was written to commemorate
the death of Blaunche, Duchess of Lancaster and wife of John of Gaunt. See Colin
Wilcockson, ‘Introduction to the Book of the Duchess’, RC, pp.329-30 (p.329).
329
from the narrator’s own melancholy to the knight’s story as it ‘displaces the dreamer’s
narration of himself and relieves his self-absorption’.103 Again, the Black Knight is not
given a nominal medical condition although, following his complaint on meeting the
dreamer, his mourning is described using technical, medical language:
Hys sorwful hert gan faste faynte
And his spirites wexen dede;
The blood was fled for pure drede
Doun to hys herte, to make hym warm For wel hyt feled the herte had harm […]
For hyt ys membre principal
Of the body; and that made al
Hys hewe chaunge and wexe grene
And pale, for ther noo blood ys sene
In no maner lym of hys (488-99).
Adin E. Lears notes how this humoral description of melancholy connects the knight
with the dreamer and that the knight’s ‘interior currents seem to feed into his flood of
words, as if his ‘complaynte’ were merely another form of fluid in his body’s fungible
economy of humors’.104 The intermingling of language and humoral fluids allows the
narrator to hinge between the dramatic flux taking place within the body and its outer
appearance manifested in the knight’s pale complexion. But despite the technical
knowledge employed in this description, the Knight refutes medicine and other healing
103
Nancy Ciccone, ‘The Chamber, the Man in Black, and the Structure of Chaucer’s
Book of the Duchess’, The Chaucer Review, 44:2 (2009), 205-223 (p.209).
104
Adin Esther Lears, ‘Something from Nothing: Melancholy, Gossip, and Chaucer’s
Poetics of Idling in the Book of the Duchess’, The Chaucer Review, 48:2 (2013), 205221 (p.211).
330
strategies when the dreamer suggests that telling his sorrows might help relieve his
heart:
Nought al the remedyes of Ovyde,
Ne Orpheus, god of melodye,
Ne Dedalus with his playes slye;
Ne hele me may no phisicien,
Noght Ypocras ne Galyen (569-72)
The black knight’s condition is both defined through recourse to medical definitions
and, conversely, through a negation of medicine as a healing enterprise. Medicine
proffers a language in which melancholic sorrow can be elucidated and attached to the
sufferer’s subjectivity. The rendering visible of the internal body through humoral
language informs this subjectivity as much as the incapacity of the greatest medical
healers. This vague condition thus outlines the sufferer’s relationship with the world in
terms of oppositions where laughter is turned to weeping, ‘glade thoghtes to hevynesse’
(601) and ‘hele ys turned into seknesse’ (607).
The technical vocabulary of humoral theory that enables the delineation of the
suffering subject here is aided by the vague description of melancholia, hinging
between a physical sickness and a mental or spiritual condition. It is the diffuse nature
of medical language that makes it amenable to such literary employment in Chaucer’s
text. I have shown how the susceptibility of medical language to metaphorisation and
moralisation contribute to its diverse usages. This can be seen in ‘Adam Scriveyn’ in the
way that the diseased body is figured as a means of imagining the misrepresentation of
language and textual defacement. I have also shown its adoption in elucidating a range
of philosophical themes by the applicability of its tenets as ‘truisms’ pertaining to life in
general. Whilst medical satire is certainly a feature of Chaucerian medicine, this is part
of a wider engagement with the physical, philosophical and spiritual potentialities of
331
medical language. Therefore, whilst it signifies medical authority, practical knowledge
and a quasi-religious healing potential, it can simultaneously symbolise rhetorical
emptiness and restorative failure. Chaucer identifies in medical language a sensitivity to
the metaphorical potential and performative efficacy of practical and technical writing;
this informs his literary appropriation of medical language both in terms of gesturing
towards its fallibility, its edifying orientation and its health-inducing claims.
332
Conclusion
This thesis has identified a malleable and fecund medical register at work across a
variety of Middle English writings. Medical language could supply metaphors to
elucidate a variety of different concepts, philosophical and religious, or it could be
employed to navigate between metaphorical tenor and vehicle to blur the distinction
between illness and sin, the body and the soul. It provided a terminology that was
geared towards articulating a total knowledge of the body, inside and outside, that
proved germane to religious efforts to detail and illuminate the workings of the soul,
particularly in its relationship to the body. It could signal technical proficiency and
suggest a semantic stability overlaid with social or political authority. Such a medical
register was liable to be mobilised in the construction and delineation of subjective
states and identities; it lent itself to a poetics of care and charity as well as of distancing,
disgust and exclusion.
Yet the cultural absorption of medical discourse was itself the subject of tensions.
We have seen how the Fourth Lateran Council, in its proclamation of injunctions
betraying suspicions of medical practitioners, was itself susceptible to the allure of
medical imagery in furnishing its arguments. A similar dynamic tension, between
incorporating medical discourse and subverting it, is evident in the fifteenth-century
miracle play, the Croxton Play of the Sacrament. This drama concerns a group of Jews
who subject the Eucharistic Host to an array of ‘trials’ in an attempt to disprove its
divine nature. This vivid and markedly anti-Jewish text can thus be seen as an attempt
to authenticate through violent and comic performance the real presence of Christ in the
Host. Although it is set in the kingdom of Aragon, it is thought to have been written in
East Anglia to be performed in various places including Bury St. Edmunds. It is extant
333
in just one mid-sixteenth-century manuscript, although it is likely that the play was
written in the later fifteenth century, at some point after 1461, the year in which it is
set.1 The Jews, having intercepted the Host, ‘subject it to a symbolic second Passion’2
by stealing, stabbing and nailing it to a post before finally placing it in an oven; this
eventually shatters to reveal an image of Christ ‘with woundys bledyng’, as the stage
directions stipulate.3 During the course of these symbolic tortures the hand of Jonathas,
the group’s leader, sticks to the Host, and the efforts of the others to free him result in
its severance.4 He is eventually healed by Christ but not before the Jews repent, accept
1
The Croxton referred to in the title is mentioned in the play’s banns included in the
text. Its location in southern Norfolk near Bury St. Edmunds is indicated by the
reference in the play to ‘Babwell’, a neighboring town. See Norman Davis, ‘The Play of
the Sacrament’, in Non-Cycle Plays and Fragments, ed. by Norman Davis, EETS s.s.1
(London: Published for Early English Text Society by Oxford University Press, 1970),
pp.lxxxiv-lxxxv.
2
Greg Walker, ‘Introduction’, in ‘Croxton, The Play of the Sacrament’, in Medieval
Drama: An Anthology, ed. by Greg Walker (Oxford: Blackwell, 2000), pp.213-14
(p.213).
3
Play of the Sacrament, in Medieval Drama, ed. by Greg Walker, pp.214-33 (p.228);
citations of the play are by line number in the main text. On the European tradition of
host desecration narratives, see Miri Rubin, ‘Desecration of the Host, the Birth of an
Accusation’, in Christianity and Judaism: Papers read at the 1991 Summer Meeting
and the 1992 Winter Meeting of the Ecclesisatical History Society, ed. by Diana Wood
(Oxford: Blackwell, 1992), pp.169-85.
4
On the significance of the Jew’s hand in late medieval culture, see Bale, Feeling
Persecuted, pp.90-117.
334
the doctrine of Eucharistic transubstantiation and convert to Christianity.5 This narrative
arc is paralleled by the theatrical performance of the ‘new’ Passion as the host is
tortured and re-crucified, to emerge embodied as the suffering man of sorrows forgiving
his torturers and offering redemption from sin.
Halfway through the play, this series of events is halted for a comic interlude
featuring the appearance of a physician, Master Brundyche and his wise-cracking
servant, Colle. This scene, immediately following the amputation of Jonathas’s hand,
portrays Brundyche as an inept and self-serving physician who offers to heal Jonathas
but is refused. The scene, in this way, does not appear to offer narrative progress or
resolution but instead lampoons some of the perceived negative traits of late medieval
medical practitioners. The relationship of this scene to the wider play has been the
subject of a good deal of critical discussion. Until quite recently, a consensus endured
which viewed it as an interpolation, a later addition to the play based on stock characters
in folk plays, which bore little relation to the theological themes explored in the main
narrative.6 But there has also been an alternative insistence by some on the connections
between both.7 Victor Scherb, in particular, argues that the interlude is both,
5
The doctrine of transubstantiation asserts the real presence of Christ in the bread that is
blessed during the sacrament of the Eucharist.
6
Hardin Craig, one of the first critics to propose the interpolation theory, cites the shift
in stanzaic form which characterises the scene as well as the absence of it from the
Banns as evidence. See Craig, English Religious Drama of the Middle Ages (Oxford:
Clarendon, 1955), pp.326–27. However, it should be noted that the Banns also omit the
pivotal sequence involving the sticking of Jonathas’s hand to the host, demonstrating
that they are not to be read as a comprehensive outline of the plot. Others argue that the
interpolation is carried over from Mummers’ fertility plays featuring the stock character
335
a knowledgeable parody and a refutation of fifteenth-century rural medical
practice in favour of the divine physician […]. While the subject of medicine per
of a bumbling, comic doctor arriving to revive a dead knight. See Davis, ‘The Play of
the Sacrament’, p.lxxv. Greg Walker argues that it establishes ‘a comic counterpoint to
the more serious matter that it interrupts’. See Walker, ‘Introduction’, p.214. For similar
perspectives see Elisabeth Dutton, ‘The Croxton Play of the Sacrament’, in The Oxford
Handbook of Tudor Drama, ed. by Thomas Betteridge and Greg Walker (Oxford:
Oxford University Press, 2012), pp.55-71 (p.58), and Darryll Grantley, ‘Saints’ Plays’,
in The Cambridge Companion to Medieval English Theatre, ed. by Richard Beadle
(Cambridge and New York: Cambridge University Press, 1994), pp.265–89 (p.284).
7
David Lawton and John T. Sebastian both argue that the metrically complex verses
through which Brundyche and Colle are represented suggest more of an affinity with the
European genre of estates satire than with folk plays. See John T. Sebastian,
‘Introduction’, in Croxton Play of the Sacrament, ed. by John T. Sebastian (Kalamazoo,
MI: Medieval Institute Publications, 2012)
https://www.lib.rochester.edu/camelot/teams/sjcspint.htm [accessed 11 August 2014],
and David Lawton, ‘Sacrilege and Theatricality: the Croxton Play of the Sacrament’,
Journal of Medieval and Early Modern Studies, 33:2 (2003), 281-309 (p.292). Lawton
cites the Arras plays of the twelfth and thirteenth centuries, notably Alan de la Halle’s
Jeu de la Feuillée, as examples of the representation of practitioners in metrically
sophisticated drama.
336
se is only incidental to the main theme of the play, the dramatist skilfully
integrates the opposed motifs of spiritual and physical healing.8
Scherb sees the interlude, then, as offering a different, subordinated idea of healing than
the divine, soteriological one the wider play is concerned with. Whilst this perspective
rightly identifies the way the playwright seeks to establish a hierarchy between divine
and secular healing through the inclusion of the physician scene, it overlooks the wider
play’s incorporation of a medical register in its references to healing and salvation. The
focus of this thesis on the productive character of medical language in late medieval
English writings allows an identification of the way that medicine, through its shared
vocabulary with Christian salvational discourse, is integral to the primary concerns of
the Play of the Sacrament. This is particularly so in terms of the way medicine is
implicated in the play’s general concern about the performative efficacy of sacramental
language.
8
Victor I. Scherb, ‘The Earthly and Divine Physicians: Christus Medicus in the Croxton
Play of the Sacrament’, in The Body and the Text: Comparative Essays in Literature
and Medicine, ed. by Bruce Clarke and Wendell Aycock (Lubbock: Texas Tech
University Press, 1990), pp.161-71 (p.162). The contrast between the earthly and divine
physicians in the play was first made by Sister Nicholas Maltman in ‘Meaning and Art
in the Croxton Play of the Sacrament’, Journal of English Literary History, 41:2 (1974),
149-64. For similar views, see Richard L. Homan, ‘Devotional Themes in the Violence
and Humour of the Play of the Sacrament’, Comparative Drama, 20:4 (1986-7), 327340 (pp.328 and 332-4); Steven F. Kruger, ‘The Bodies of Jews in the Late Middle
Ages’, in The Idea of Medieval Literature: New Essays on Chaucer and Medieval
Culture in Honor of Donald R. Howard, ed. by James M. Dean and Christian K. Zacher
(Newark and London: University of Delaware Press,1992), pp.301-23 (p.314).
337
The configuration of medical practice in terms of ambiguous, vacillating language
is a marked feature of the medical interlude. The effectiveness of Colle’s jibes at the
expense of his master, Brundyche, incorporates a variety of puns and wordplay. 9 The
comedy of the scene gains impetus from the split between Brundyche’s literal-minded
understanding of Colle’s language and the audience’s appreciation of its equivocal
poise. For instance, Colle introduces his master in a fittingly superlative mode as ‘þe
most famous phesy[cy]an þat ever sawe uryne’ (455-6), but undercuts it by the followup statement implying Brundyche’s blindness saying that he ‘Can gyff a jud[g]yment
aryght; / As he þat hathe noon eyn’ (459-60). The implicit criticism of medical practice
is extended when Colle, at Brundyche’s request, proclaims the doctor’s skills to the
audience.
All manar off men þat have any syknes,
To Master Brentberecly loke þat yow redresse!
What dysease or syknesse þat ever ye have,
He wyll never leve yow tyll ye be in yow[r] grave.
Who hat þe canker, þe collyke, or þe laxe,
The tercyan, þe quartan, or þe brynny[n]g axs;
For wormys, for gnawyng, gryndy[n]g in þe wombe or in þe boldyro;
All maner red eyn, bleryd eyn, and þe myegrym also;
For hedache, bonache, and therto þe tothache;
The colt-evyll, and þe brostyn men he wyll undertak,
All tho þat [have] þe poose, þe sneke, or þe tyseke.
Thowh a man w[e]re ryght heyle, he cowd soon make hym seke! (528-39).
9
Robert Weimann connects Colle in this play with other underlings or servants in
mystery plays whose comic punning serves to introduce confusion and comic power
inversions. See Weinmann, Shakespeare and the Popular Tradition in the Theater:
Studies in the Social Dimension of Dramatic Form and Function (Baltimore: John
Hopkins University Press, 1978), pp.138-9.
338
Colle’s proclamation here is again imbued with satire, undercutting the claim of
Brundyche’s diligence by the suggestion that he will never leave his patients until they
are dead and that he can make healthy people sick. The salient rhythmic triplets,
consistent rhyming and heavy aureation of the speech also suggest a medical practice
based upon rhetoric.10 The taxonomic delineation of genera of illnesses and listing of
body parts is part of a performative display of knowledge and learning that, in the
context of Brundyche’s implied inadequacies, suggests empty bluster.11
Yet the hierarchy that the playwright seeks to institute through the medical
interlude is disturbed by the way that some medical references are seen as
indistinguishable from spiritual ones. This reflects an apprehension, evident in the play,
concerning the way that language, particularly the language of healing, is susceptible to
indeterminacy and prevarication. When Brundyche arrives on stage, Colle asks him
about one of his patients:
Colle: But master, I pray yow, how dothe yowr pa[c]yent
That ye had last under yowr medycament?
10
Linda Ehrsam Voigts’s recent identification of a rare text of fifteenth-century banns
proclaiming the abilities of an itinerant medical practitioner (possibly in the Norfolk
area) strongly resembles Colle’s proclamation in its use of repetition and comprehensive
listing of ailments and cures. See Voigts, ‘Fifteenth-Century English Banns Advertising
the Services of an Itinerant Doctor’, in Between Text and Patient, ed. by Florence Eliza
Glaze and Brian K. Nance (Florence: SISMEL, 2011), pp.245-77. The text is in
London, BL Harley MS 2390. ff.105-106v.
11
On Colle’s listing of medical ingredients drawn from contemporary medical
literature, see Scherb, ‘Earthly and Divine Physicians’, p.166.
339
Master Brundyche: I waraunt she never fele anoyntment.
Colle: Why, ys she in hyr grave?
Master Brundyche: I have gyven hyr a drynke made full well
Wyth scamoly and with oxennell,
Letwyce, sawge, and pympernelle.
Colle: Nay, than she ys full save! (501-8)
The stichomythic question-and-answer format heightens the comedy here as Colle’s
fast-paced punning has the effect of setting up and deflating Brundyche’s pretensions to
knowledge and expertise. In one sense, this again serves to undermine medical healing:
Colle implies that Brundyche’s medicinal herbs have only succeeded in killing his
patient. Yet the punning is rendered effective by the spiritual resonances of the language
employed in the passage. Brundyche answers Colle’s question by affirming that his
patient never felt ‘anoyntment’. Greg Walker, in his edited version of the play, glosses
‘anoyntment’ as annoyance or pain, and so interprets Brundyche’s line as indicating that
his patient has not felt pain as a result of the treatment.12 But the various meanings of
the noun ‘anoyntment’ also include a medical unguent, embalming oil and the
administration of the sacrament of extreme unction.13 Colle’s answer, ‘Why, ys she in
hyr grave?’, is thus a provocative reinterpretation of Brundyche’s answer, exploiting the
sacramental associations of ‘anoyntment’. Brundyche continues unperturbed listing the
ingredients of a medical purgative he has given her.14 This prompts Colle’s further
12
Walker, ed., Play of the Sacrament, p.225, see gloss for l. 503.
13
‘enointment’. n’, MED. http://quod.lib.umich.edu/cgi/m/mec/med-
idx?type=id&id=MED13928 [accessed 25 September 2014].
14
Linda Voigts argues that this mixture of ingredients is ‘certainly a purgative’. See
Voigts, ‘Fifteenth-Century English Banns’, p.270.
340
ambiguous response, ‘she ys full save’, which works both as a satirical confirmation of
the putative success of Brundyche’s treatment and a reference to the state of the
(inferred) dead patient’s soul. The latter meaning is given added force by the suggestion
that Brundyche’s purgative has itself worked as a form of spiritual purgation resulting in
the soul’s salvation.
This dialogue signifies something more than a mere comic satire against medical
practice and the spiritual blindness of its practitioners: it registers an uneasy overlaying
of medical and religious discourse, where the practice of anointing someone refers to
both the secular medical enterprise of treating the living and the sacramental one of
caring for the souls of the dead. This discursive interlacing is the point where the
medical interlude connects most forcefully with the concerns of the wider play. The
main action, predicated on the inversion of the Eucharistic ritual, is an exploration of the
divine potency of the words said by the priest in performing it, and attempts to present
what happens when this privileged language is subject to ridicule or critique. The
overlapping between the medical and the spiritual in the play, whilst employed to affirm
a hierarchy that privileges the spiritual, also works to inform the play’s concerns of the
debasing of liturgical language. If sacramental terms such as ‘anoyntment’ are subject to
multiple significations, as made explicit in Colle’s speech, the exclusivity and spiritual
efficacy of such language is called into question.
Indeed, this questioning is brought to bear directly on liturgical language earlier in
the play when the Christian merchant Aristorius is tasked with obtaining the Eucharistic
host for Jonathas. He accomplishes this by offering the priest, Sir Isoder, a meal, in
341
order to distract him and induce somnolence.15 Aristorius charges his clerk to obtain the
bread and wine for the supper. The clerk replies:
Syr, here ys a drawte of Romney Red;
Ther ys no better in Aragon,
And a lofe of lyght bred;
It ys holesom, as sayeth þe fesycyon (260-3).
For Scherb, this episode registers a disjuncture between the sacramental and the
material as it is based upon a contrast between ‘the efficacy of the unblessed bread and
wine that, despite their supposed medicinal qualities, will produce only drunkness and
sloth, and the sacramental feast that truly will produce spiritual health’.16
Yet there is again a more fundamental overlap between sacramental and medical
language, which grates against the play’s hierarchical distinction between medical and
Christian healing. The inversion of the sacrament in this passage is instituted through
the appropriation of its materials towards enabling the theft and debasement of the host.
The transformative potency of the sacramental bread and wine is invoked not to effect
the presence of Christ, but to achieve instead the bathetic object of encouraging Sir
Isoder’s lethargy and drunkenness. This hinging between the spiritual and the material
is exemplified by the reference to the ‘fesycyon’. In one sense the sacramental
framework informing this passage (and the wider play) would suggest that it refers to
15
This scene itself is an inversion of the ‘Last Supper’ of Christ and the Apostles, the
Eucharistic meal celebrated in the liturgy.
16
Scherb, ‘Earthly and Divine Physicians’, p.164.
342
the Christus medicus;17 but the immediate context of the reference, insisting upon the
capability of the bread and wine to engender physical change, calls up the advisory role
of physicians of outlining correct diet and lifestyle in medical regimens. The crucial
point is that the ambiguity concerning who the ‘fesycyon’ is (as well as the use of the
adjective ‘holesom’ connoting both physical and spiritual wellbeing) instructs the
Eucharistic parody taking place in this scene. The bread and wine signify both the
sacramental economy and the physical alteration produced through medical
intervention, cynically deployed by Aristorius in this scene, and this is made possible
through the existence of a shared referential framework that medical and spiritual
discourse have in common.
The very censure of medical practice in the play, through its presentation of
Colle’s wordplay and Brundyche’s myopia, as well as the rhetorical display of
knowledge in Colle’s recitation of Brundyche’s expertise, is riveted to apprehensions of
the integrated relationship between medical and spiritual language. This subtle tension
may be indicated when, at the end of Colle’s proclamation, he mentions that Brundyche
can be found in a coal-shed ‘a lytyll besyde Babwell Myll’ (541). Much has been made
of this reference as it helps to further locate the play in Bury St. Edmunds where
Babwell Mill was situated. Gail McMurray Gibson proposes that, for the play’s
contemporary East Anglian audience, the reference to Babwell Mill would have been
associated with St. Saviour’s hospital, a well-known institution situated nearby that
housed sick and infirm patients. She goes on:
17
John T. Sebastian, in glossing the term in his edition of the play, speculates that the
term might refer to the Christus medicus tradition. See note for l.342 in Sebastian, ed.,
Croxton Play.
343
For the local and knowing audience, the play’s reference to a doctor near Babwell
Mill would have evoked the name of the actual hospital there, the hospital of St.
Saviour, even as the play exists to affirm the true physician. It will be St. Saviour
himself, the crucified saviour of mankind, who will finally […] heal Jonathas’
hand.18
But if Babwell Mill, and the corresponding image of the physician residing in its
vicinity, would evoke, for the audience, the Christus medicus, it also situates this image
in the shadow of a degraded language: the name is yet another example of Colle’s
punning allowing him to connect Brundyche’s temporary residence with a suggestion
that he is a babbling fool. The implication is affirmed a few lines later as Jonathas, in
rejecting Brundyche’s attempt to heal his severed hand, says to both, ‘Avoyde, fealows,
I love not yowr bable!’ (570).
In this context, ‘bable’ signifies the meaninglessness and empty rhetoric with
which Brundyche and Colle, and, by implication, medical practitioners, are associated
in the play; this shows its impetus to assert a univocal meaning over the semantic
proliferation that the wordplay and use of medical terminology in the interlude triggers.
But, as the shifting between medical and sacramental registers in the wider play reveals,
such multiplicity is often inscribed in the language itself. Indeed, this thesis has charted
how a late medieval appropriation of a technical discourse, that could give voice to
internal states and subjective experience, could be tempered by ambivalence and
suspicion towards its signifying efficacy; this is illustrated in the above reading of the
Play of the Sacrament as well as in the epistemic uncertainty brought about through the
Host’s satirically faltering attempts in using medical terminology in the Canterbury
Tales.19 The Host’s confusion between religious and medical terms is evidence of the
18
Gibson, The Theater of Devotion, p.38.
19
The Canterbury Tales, RC, VI, 311-317.
344
heterogeneous quality of medical language in the late medieval English vernacular.
Although the hierarchical relationship between religious authorities and medical
practitioners may have sometimes been taut, it was characterised, at a linguistic level,
by integration.
It acquired potency through the blending of the technical, Latinate vocabulary
inherited from the scholastic European tradition (articulating disease types, medical
equipment and anatomical and humoral theories) with morally inflected and spiritually
resonant terms such as ‘helthe’, ‘patient’, ‘cure’, ‘ille’, and ‘disese’. We have seen in
these pages how, in the case of the patient, the Christian qualities of submission and
fortitude exemplified in the word were embedded in its widespread use to denote the
medical subject from the fourteenth century onwards. This discursive interweaving
worked, then, to locate medical scholasticism, as it manifested itself in the English
vernacular, within a spiritual framework, whilst it furnished religious and literary
writers with a technical language that could ‘embody’ moral, theological and
philosophical concepts. The fact that the above examples of spiritually resonant medical
words retain their currency (and popular usage) in today’s medical vocabularies is
continuing testament to how firmly and seamlessly spiritual valences were incorporated
within a mainstream medical register. Indeed, I suggest that this entrenchment is one
reason why discussions of the relationship between medicine and religion amongst
historians of medicine have rarely probed the etymologies of these keywords, a
deficiency which this thesis has sought to address.
The set of concepts and knowledge offered to Middle English writers by
scholastic medicine proved highly amenable to metaphorisation. Of course the practice
of employing medical metaphors as a means to convey abstruse Christian concepts had
a long history before the Middle Ages. But, in the late medieval English context, it
345
became a pervasive and intricately developed trope as writers made liberal and often
complex use of this highly schematised body of knowledge. Judith Anderson’s
assessment that metaphorical language is ‘a constructive force in the historical
development of cultural meaning’ is a useful way to conceive of how medical
metaphors gave definition to representations of both medicine and Christianity in late
medieval England.20 In this sense, religious practices, like confession, and doctrines,
such as those of salvation and sin, can be seen as being inflected through images of
medical practice and procedures. By earthing religious ideas in the ailing body, they
could be rendered more immediate and more evocative of the quotidian lives of
devotees. In a culture that privileged the assimilation of ideas through material, tactile
and emotional engagement, the recourse to medical imagery by religious authors would
have been opportune. Additionally, the appropriation of scholastic medical language
could itself signify authority and erudition. The magnitude of religious texts
incorporating such imagery thus reveals how medical language was a constitutive force
in the articulation of Christian ideas.
But medicine also accretes meaning in such metaphorical encounters: its
knowledge and its techniques are validated as it is brought into alignment with core
Christian concepts. I have shown the knotted legacies underlining John of Arderne’s use
of metaphors in his surgical writings. Arderne employs the medical metaphors that had
become a staple of confessional discourse, but he (re)applies them to the medical
context. This allows him to assume the authority of the priest, counselling his
apprehensive patient before the surgical procedure. He thus adopts a rhetorical mode
20
Judith Anderson, Translating Investments: Metaphor and the Dynamic of Cultural
Change in Tudor-Stuart England (New York: Fordham University Press, 2005), p.2.
346
that incorporates medical imagery to explicate religious practices as a means of
legitimising his own surgical practice. The result is a collapsed metaphor where vehicle
and tenor are no longer distinguishable, and where the medical process slips between
exemplifying soteriological principles and being advanced itself as a means to salvation.
Yet this metaphorical gliding between signifier and referent is not exclusive to a
surgical text such as Arderne’s: it is an abiding feature of the use of medical metaphors
in a variety of religious texts. I have discussed how it is employed in leprosy
descriptions where leprous skin serves both as a symbol and a manifestation of sin. The
collapsed metaphor can indicate ruptures in the medical-religious translation, by, for
instance, undermining the divine hierarchy the metaphor is meant to engender, but it can
in other instances, such as in Arderne’s case, thicken the overlap between the two fields.
The appeal to metaphor to bolster the claims to authority by medical practitioners
forms part of a wider enterprise involving the construction of the medical subject. In
chapter two, I have detailed the way that the Middle English translation of Benventus
Grapheus’s treatise on ophthalmology describes the subject in terms of passivity and
recumbence in contrast to the agency and governance of the surgeon. The appeal to
authority by the medical practitioner is here predicated on an assimilation of his role
with that of the priest. The practitioner assumes a technical, arcane knowledge of the
internal body as the priest does of the soul, and his efficacy, as with the priest’s, is
based upon the subject’s absolute submission to his authority and expertise. Again, in
accordance with the dynamics inherent in many medical metaphors, the subject is
articulated in terms of a causal relationship between the opposite states of physical
suffering and spiritual bliss. The medical subject is typically delineated as an
aristocratic male occupying a vulnerable status (through the social reversal of obedience
to a lowly practitioner as well as by virtue of his physical ailment) charged with the
347
possibilities of spiritual as well as physical wellbeing. This rapprochement of physical
discomfiture and spiritual bliss is a feature of other types of subject too including
lovesick knights in romance literature and devotees in mystical writings. The high
degree of correspondence between representations of these medical, spiritual and
literary subjects should encourage us not to see the medical-religious interaction in
terms of linear influence but as mutually generative.
The movement from physical abasement to spiritual virtue germane to the medical
subject, as well as the configuration of this in terms of the healer’s agency, raises the
question of the role of power and authority within medical discourse. Today these issues
are often framed in terms of ‘medicalisation’ as medicine becomes implicated in the
state’s tendencies to regulate the lives and bodies of its subjects. Yet as we have seen in
the chapter on healing spaces, many of the features associated with medicalisation
today, particularly the Foucauldian idea of the assertions of a ‘normative subjectivity’,
are evident in late medieval writings and images. It is important to stress that such
features emerge in terms of a cultural imaginary and not at the level of actual historical
practices. They are particularly apparent in representations of healing spaces in
monastic customaries and rules, outlining the practices pertaining to the infirmary and
its inmates. Such directives, for instance the one drawn up for Syon Abbey in Isleworth
in the fifteenth century, outline the medical and spiritual care to be given to the patients.
Yet the imperative to care for the sick is accompanied by descriptions of rituals marking
their departure from the monastic community for the infirmary (as well as their re-entry
to that community); such rituals constitute the subject as both physically and morally
deviant. The infirmary is thus as much an exclusionary zone as one associated with the
precepts of care, and the patient’s re-entry into the community is as much an expression
of spiritual progress as it is a signifier of the restoration of physical health. The
348
translation of this dynamics of medical and spiritual healing to the prison and purgatory
reveals how the dissemination of medical language across the wider culture is paralleled
by an institutional imaginary that accommodates itself to a variety of contexts.
The identification of late medieval English culture as one imbued with a medical
poetics is most clearly seen in the intertwining of medical discourse with literary
culture. Its pervasiveness across such a variety of genres indicates the importance of this
poetics to the development of English literary language. The diverse and culturally
resonant images accompanying Arderne’s works, along with the identification of a nonsurgical readership for them, attest to their close proximity to literary culture. Chaucer’s
engagement with medical language encapsulates the incorporation of this new English
medical vocabulary as a feature of literary discourse. Chaucerian medicine ranges over
a variety of modes: it questions the place of medical practitioners in late medieval
society, it represents the Boethian idea of language as health inducing (a concern of
Arderne’s too), and it probes the metaphorical and symbolic significance of medical
terms. This heterogeneous approach to medicine is reflected in the circulation of
medical material in the fourteenth and fifteenth centuries where scholastic material
travelled with popular ‘folk’ remedies, often interspersed with other fachliteratur and
various genres, including romance and devotional texts. This tradition places a literary
figure such as Chaucer alongside a surgical author such as Arderne. Likewise,
Chaucerian medicine reflects the fluid and multi-faceted nature of medical discourse in
late medieval England.
The productive relationship between medical language and spiritual, moral and
literary discourse is evinced in the wide amount of Middle English literature that
employs medical images, concepts and knowledge. This thesis has ranged over a
significant amount of such material encompassing romance literature, saints’ lives,
349
monastic customaries, visionary literature, sermons, medical treatises, public records,
manuscript illustrations, carvings and stained-glass images. In doing so it has borne
witness to the integrated quality of medical, religious and literary languages in late
medieval culture, and to their mutually sustaining characteristics. It has identified how
medical knowledge and learning provided a pliable register that could be marshalled by
writers engaging with a spectrum of themes and ideas including moral instruction,
philosophy, mysticism, discipline, regulation, social satire and spiritual exemplarity. It
has shown how late medieval English culture is to be understood as one suffused with a
medical poetics that could shape representations of the subject, make visible the internal
body and soul and chart the synaptic relationship between the physical and the spiritual,
the ailing and the healthy body.
350
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